Focal functional deficits in temporal lobe epilepsy on PET scans and the intracarotid amobarbital procedure

Comparison of patients with unitemporal epilepsy with those requiring intracranial recordings

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22 Citations (Scopus)

Abstract

Purpose: To analyze the relationship between the intracarotid amobarbital procedure (IAP) and positron emission tomography (PET) and study the lateralizing value of these tests in patients with unitemporal epilepsy and those requiring intracranial recordings. Methods: We compared 51 patients with unitemporal epilepsy (group 1) with 26 patients in whom surface recordings tailed to reveal a distinct unitemporal focus, necessitating invasive recordings (group 2). Results: The brain magnetic resonance imaging (MRI) scans for group 1 showed mesial temporal sclerosis in 70.5% of the patients. PET showed unilateral temporal hypometabolism in 88%. In addition, 74.5% of the patients in group I had impaired memory on the epileptogenic side on the IAP, and 89.4% of those patients also had ipsilateral temporal hypometabolism on PET scans. All the group 1 patients underwent temporal resections. The pathologic examination showed hippocampal sclerosis in 72% of the patients. Eighty percent of group 1 patients became seizure free, and 16% had rare seizures (follow-up, 2-7 years). MRIs for group 2 showed mesial temporal sclerosis in 31% of the patients: PET scans showed temporal hypometabolism in 39%. The IAP was lateralized in 47.8%. Sixty-nine percent had temporal lobe resections. The pathologic examination showed hippocampal sclerosis in 44% of the patients. Forty-four percent of group 2 patients became seizure free, and 27.7% had rare seizures (follow-up, 2-8 years). Conclusions: Ninety-six percent of the patients with unitemporal foci had focal functional deficits on the epileptogenic side on 18-fluorodeoxyglucose-(FDG) PET scans, the IAP, or both. The results of the FDG-PET were predictive of impaired memory on the IAP. Memory impairment contralateral to the temporal hypometabolism found on the PET scans was never seen. These patients had an excellent outcome. In contrast, <50% of the patients requiring intracranial recordings had focal functional deficits, suggesting that more a diffuse pathology may account for their less favorable outcome.

Original languageEnglish
Pages (from-to)198-203
Number of pages6
JournalEpilepsia
Volume42
Issue number2
DOIs
StatePublished - 2001

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Amobarbital
Temporal Lobe Epilepsy
Positron-Emission Tomography
Epilepsy
Sclerosis
Seizures
Temporal Lobe

Keywords

  • FDG-PET
  • IAP
  • Outcome
  • Pathology
  • Temporal lobe epilepsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

@article{e61dc281c6b94e49aa425263b5598d5b,
title = "Focal functional deficits in temporal lobe epilepsy on PET scans and the intracarotid amobarbital procedure: Comparison of patients with unitemporal epilepsy with those requiring intracranial recordings",
abstract = "Purpose: To analyze the relationship between the intracarotid amobarbital procedure (IAP) and positron emission tomography (PET) and study the lateralizing value of these tests in patients with unitemporal epilepsy and those requiring intracranial recordings. Methods: We compared 51 patients with unitemporal epilepsy (group 1) with 26 patients in whom surface recordings tailed to reveal a distinct unitemporal focus, necessitating invasive recordings (group 2). Results: The brain magnetic resonance imaging (MRI) scans for group 1 showed mesial temporal sclerosis in 70.5{\%} of the patients. PET showed unilateral temporal hypometabolism in 88{\%}. In addition, 74.5{\%} of the patients in group I had impaired memory on the epileptogenic side on the IAP, and 89.4{\%} of those patients also had ipsilateral temporal hypometabolism on PET scans. All the group 1 patients underwent temporal resections. The pathologic examination showed hippocampal sclerosis in 72{\%} of the patients. Eighty percent of group 1 patients became seizure free, and 16{\%} had rare seizures (follow-up, 2-7 years). MRIs for group 2 showed mesial temporal sclerosis in 31{\%} of the patients: PET scans showed temporal hypometabolism in 39{\%}. The IAP was lateralized in 47.8{\%}. Sixty-nine percent had temporal lobe resections. The pathologic examination showed hippocampal sclerosis in 44{\%} of the patients. Forty-four percent of group 2 patients became seizure free, and 27.7{\%} had rare seizures (follow-up, 2-8 years). Conclusions: Ninety-six percent of the patients with unitemporal foci had focal functional deficits on the epileptogenic side on 18-fluorodeoxyglucose-(FDG) PET scans, the IAP, or both. The results of the FDG-PET were predictive of impaired memory on the IAP. Memory impairment contralateral to the temporal hypometabolism found on the PET scans was never seen. These patients had an excellent outcome. In contrast, <50{\%} of the patients requiring intracranial recordings had focal functional deficits, suggesting that more a diffuse pathology may account for their less favorable outcome.",
keywords = "FDG-PET, IAP, Outcome, Pathology, Temporal lobe epilepsy",
author = "Vicenta Salanova and Omkar Markand and R. Worth",
year = "2001",
doi = "10.1046/j.1528-1157.2001.17200.x",
language = "English",
volume = "42",
pages = "198--203",
journal = "Epilepsia",
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T1 - Focal functional deficits in temporal lobe epilepsy on PET scans and the intracarotid amobarbital procedure

T2 - Comparison of patients with unitemporal epilepsy with those requiring intracranial recordings

AU - Salanova, Vicenta

AU - Markand, Omkar

AU - Worth, R.

PY - 2001

Y1 - 2001

N2 - Purpose: To analyze the relationship between the intracarotid amobarbital procedure (IAP) and positron emission tomography (PET) and study the lateralizing value of these tests in patients with unitemporal epilepsy and those requiring intracranial recordings. Methods: We compared 51 patients with unitemporal epilepsy (group 1) with 26 patients in whom surface recordings tailed to reveal a distinct unitemporal focus, necessitating invasive recordings (group 2). Results: The brain magnetic resonance imaging (MRI) scans for group 1 showed mesial temporal sclerosis in 70.5% of the patients. PET showed unilateral temporal hypometabolism in 88%. In addition, 74.5% of the patients in group I had impaired memory on the epileptogenic side on the IAP, and 89.4% of those patients also had ipsilateral temporal hypometabolism on PET scans. All the group 1 patients underwent temporal resections. The pathologic examination showed hippocampal sclerosis in 72% of the patients. Eighty percent of group 1 patients became seizure free, and 16% had rare seizures (follow-up, 2-7 years). MRIs for group 2 showed mesial temporal sclerosis in 31% of the patients: PET scans showed temporal hypometabolism in 39%. The IAP was lateralized in 47.8%. Sixty-nine percent had temporal lobe resections. The pathologic examination showed hippocampal sclerosis in 44% of the patients. Forty-four percent of group 2 patients became seizure free, and 27.7% had rare seizures (follow-up, 2-8 years). Conclusions: Ninety-six percent of the patients with unitemporal foci had focal functional deficits on the epileptogenic side on 18-fluorodeoxyglucose-(FDG) PET scans, the IAP, or both. The results of the FDG-PET were predictive of impaired memory on the IAP. Memory impairment contralateral to the temporal hypometabolism found on the PET scans was never seen. These patients had an excellent outcome. In contrast, <50% of the patients requiring intracranial recordings had focal functional deficits, suggesting that more a diffuse pathology may account for their less favorable outcome.

AB - Purpose: To analyze the relationship between the intracarotid amobarbital procedure (IAP) and positron emission tomography (PET) and study the lateralizing value of these tests in patients with unitemporal epilepsy and those requiring intracranial recordings. Methods: We compared 51 patients with unitemporal epilepsy (group 1) with 26 patients in whom surface recordings tailed to reveal a distinct unitemporal focus, necessitating invasive recordings (group 2). Results: The brain magnetic resonance imaging (MRI) scans for group 1 showed mesial temporal sclerosis in 70.5% of the patients. PET showed unilateral temporal hypometabolism in 88%. In addition, 74.5% of the patients in group I had impaired memory on the epileptogenic side on the IAP, and 89.4% of those patients also had ipsilateral temporal hypometabolism on PET scans. All the group 1 patients underwent temporal resections. The pathologic examination showed hippocampal sclerosis in 72% of the patients. Eighty percent of group 1 patients became seizure free, and 16% had rare seizures (follow-up, 2-7 years). MRIs for group 2 showed mesial temporal sclerosis in 31% of the patients: PET scans showed temporal hypometabolism in 39%. The IAP was lateralized in 47.8%. Sixty-nine percent had temporal lobe resections. The pathologic examination showed hippocampal sclerosis in 44% of the patients. Forty-four percent of group 2 patients became seizure free, and 27.7% had rare seizures (follow-up, 2-8 years). Conclusions: Ninety-six percent of the patients with unitemporal foci had focal functional deficits on the epileptogenic side on 18-fluorodeoxyglucose-(FDG) PET scans, the IAP, or both. The results of the FDG-PET were predictive of impaired memory on the IAP. Memory impairment contralateral to the temporal hypometabolism found on the PET scans was never seen. These patients had an excellent outcome. In contrast, <50% of the patients requiring intracranial recordings had focal functional deficits, suggesting that more a diffuse pathology may account for their less favorable outcome.

KW - FDG-PET

KW - IAP

KW - Outcome

KW - Pathology

KW - Temporal lobe epilepsy

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