Video-electroencephalography Applied in Interpretation of Cortical and Subcortical Hypermetabolic Foci in Interictal 18 F-fluorodeoxyglucose Positron Emission Tomography Imaging in Patients with Epilepsy
10.3969/j.issn.1674-9081.2015.01.004
- VernacularTitle:脑电监测在癫痫患者间期皮层和皮层下高代谢灶判读中的应用
- Author:
Na NIU
1
;
Rui-Xue CUI
;
Ying ZHANG
;
Fang LI
Author Information
1. 中国医学科学院 北京协和医学院 北京协和医院核医学科
- Keywords:
epilepsy;
vedio-electroencehpalography monitoring;
positron emission tomography imaging;
hypermetabolic focus
- From:
Medical Journal of Peking Union Medical College Hospital
2015;(1):18-23
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the role of vedio-electroencehpalography ( VEEG) monitoring in inter-preting the cortical and subcortical hypermetabolic foci in interictal 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography ( PET) imaging in patients with epilepsy .Methods From January 2008 to March 2014 in Peking Union Medical College Hospital , 3 epileptic patients whose first 18 F-FDG PET scan showed unexplained hypermetabolic foci without seizure underwent repeated 18 F-FDG PET scan in the interictal status proved by VEEG monitoring after discharge suppression by intravenous diazepam .Then compared the first and second scan images.Results For case 1 who suffered from epilepsy originating from medial right temporal lobe , unexplain-able hypermetabolic foci in right frontal lobe , basal ganglia , thalamus, and left cerebellum were present in in-terictal 18 F-FDG PET scan.After suppressing cortical discharge under VEEG monitoring , the second 18 F-FDG PET scan showed that the cortical and subcortical hypermetabolism disappeared , indicating that the hypermetabol-ic foci in the first scan was due to the subclinical discharge in a potential extratemporal seizure origin site , and the existence of efferent network activity from that origin site to ipsilateral basal ganglia and thalamus and contra -lateral cerebellum .The original clinical decision of simple anterior temporal lobectomy was altered based on the findings.For case 2, hypermtabolism was present in a large part of right frontal lobe , which persisted after sup-pressing discharge under VEEG monitoring .While the hypermetabolic foci in ipsilateral basal ganglia and contra-lateral cerebellum became less obvious in the second 18F-FDG PET scan, proving that the original lesion (inflam-mation) with hypermetabolism existed in the cortex , and the hypermetabolic foci in basal ganglia and thalamus were due to secondary functional change .Case 3 suffered from temporal lobe epilepsy with origin undeterminable with clinical information , electroencephalogram , or magnetic resonance imaging .Hypermtabolic left hippocampus was shown in both the first 18 F-FDG PET scan and the second PET scan under definite interictal status with VEEG monitoring , suggested the existence of a hypermetabolic lesion ( tumor ) , facilitating the clinical decision on surgical site .Conclusions For the epileptic patients with hypermetabolic foci in 18 F-FDG PET without sei-zure, repeated 18 F-FDG PET imaging in definite interictal status under VEEG monitoring can help interpret the etiology and define the extent of lesions for better clinical decision-making .
