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A Study Using Positron Emission Tomography With ¹⁸Fluorodeoxyglucose

Sophi Dupont, MD; Frank Semah, MD; Stéphane Clémenceau, MD; Claude Adam, MD; Michel Baulac, MD; Yves Samson, MD

Arch Neurol. 2000;57:1331-1336.

Background  Recent studies suggest that positron emission tomography may be a reliable predictive indicator of clinical outcome following surgical treatment for epilepsy.

Objective  We evaluated 30 patients with documented medial temporal lobe epilepsy to determine if prediction of postoperative outcome is improved with the use of positron emission tomography with ¹⁸fluorodeoxyglucose.

Patients and Methods  We performed a discriminant analysis to determine the combination of metabolic asymmetry indexes in temporal and extratemporal regions defined by magnetic resonance imaging that best predicted the postoperative outcome. Seizure outcome was assessed at least 2 years after surgery: patients were classified as seizure free (n = 14, group A), mostly improved (n = 10, group B), or as having persistent seizures (n = 6, group C).

Results  Discriminant analysis was first performed in groups A and C. The temporal pole seemed to be the only temporal region for which metabolism was a significant predictor of the postoperative outcome (F_1,18 = 10.19; P = .005). The predictive value of positron emission tomography with ¹⁸fluorodeoxyglucose was considerably improved by the multivariate analysis (F_4,15 = 7.21; P = .002), which correctly predicted the 2 -year prognosis in 100% of the patients using 4 regions: the temporal pole, the medial temporal region, the anterior part of the lateral temporal neocortex, and the basofrontal region. As a validation, we performed this 4-region analysis in the patients in group B. The difference among the 3 groups was highly significant (F = 15.5, P<.001).

Conclusion  These findings suggest that the interictal metabolic pattern reliably predicts the 2-year prognosis after surgery in patients with medial temporal lobe epilepsy.

From the Department of Nuclear Medicine, Service Hospitalier Fredéric Joliot, Commissariat à l'Energie Atomique, Orsay, France (Drs Dupont, Semah, and Samson), and the Epilepsy Unit (Drs Dupont, Clemenceau, Adam, and Baulac) and Stroke Unit (Dr Samson), Clinique P. Castaigne, Hôpital de la Salpêtrière, Paris, France.

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