Cerebral metabolic topography in unilateral temporal lobe epilepsy.
OBJECTIVE
Fluorodeoxyglucose positron emission tomography (FDG-PET) studies of temporal lobe epilepsy (TLE) generally report interictal hypometabolism in the vicinity of the seizure focus. Yet, other evidence suggests that interictal metabolic abnormalities might extend to remote brain areas. We used FDG-PET to evaluate metabolism in selected regions distant from the focus in TLE.


METHODS
Twenty adult patients with medically intractable TLE were selected by criteria favoring a unilateral mesiobasal temporal focus. Structural imaging in this sample were normal except for medial temporal sclerosis in 13 patients. Twenty normal volunteers were controls.


METHODS
PET imaging was performed interictally. Regional glucose metabolism normalized by global metabolism was analyzed using t tests and correlation analysis.


RESULTS
Ipsilateral to the seizure focus, metabolism was depressed compared with normal in the temporal pole (p = 0.001), but relatively elevated in the mesiobasal region (p = 0.005). Contralateral to the focus, metabolism was elevated in lateral temporal cortex (p = 0.0003) and mesiobasal regions (p = 0.0001). Metabolic correlation between ipsilateral and contralateral mesiobasal regions was similar in normal subjects (r = 0.74) and patients (r = 0.68). In contrast, correlations were abnormal between temporal poles and other temporal lobe subregions, both ipsilateral and contralateral to the seizure focus.


CONCLUSIONS
Relative to normal values, both elevations and depressions of metabolism exist interictally in TLE. Such abnormalities, and accompanying changes in interregional correlations, may have wide spatial distribution. These findings are atypical among PET studies but are consistent with other physiologic, anatomic, and neuropsychological investigations of TLE.
Rubin
E
E
Department of Biological Psychiatry, Columbia University/New York State Psychiatric Institute, NY, USA.
Dhawan
V
V
Moeller
J R
JR
Takikawa
S
S
Labar
D R
DR
Schaul
N
N
Barr
W B
WB
Eidelberg
D
D
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D003847:Deoxyglucose / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000378:metabolism*; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005625:Frontal Lobe / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D013702:Temporal Lobe / Q000378:metabolism; D013788:Thalamus / Q000378:metabolism; D014018:Tissue Distribution; D014055:Tomography, Emission-Computed
D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose