FDG-PET and MRI in temporal lobe epilepsy: relationship to febrile seizures, hippocampal sclerosis and outcome.
OBJECTIVE
To correlate the volumetric head magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scan findings with the history, intracarotid amobarbital procedure, pathology, and outcome in patients with medically refractory temporal lobe epilepsy.


METHODS
Thirty-eight patients with temporal lobe epilepsy treated surgically following a comprehensive presurgical evaluation. Follow-up ranged from 12 to 44 months.


RESULTS
Volumetric MRI showed ipsilateral hippocampal atrophy in 29 (76%), and PET scan showed ipsilateral temporal hypometabolism (PET-TH) in 31 (81.5%) of patients. Eighty-three percent of those patients with hippocampal sclerosis on MRI (MRI-HS) had ipsilateral PET-TH. Sixty-six percent of patients with MRI-HS had a history of prolonged febrile convulsions or a childhood febrile illness accompanied by convulsions, and 77% of patients with MRI-HS had pathologically proven hippocampal sclerosis (HS). Ninety percent became seizure free or had rare seizures.


CONCLUSIONS
FDG-PET scans and head MRIs were complementary; 95% of patients had either MRI-HS or temporal hypometabolism. MRI-HS correlated with a history of febrile seizures and pathologically demonstrated hippocampal sclerosis. Ninety-three percent of patients had focal functional deficits on the epileptogenic side. Concordance between PET temporal hypometabolism and MRI-HS correlated with better outcome.
Salanova
V
V
Department of Neurology, Indiana University School of Medicine, Indianapolis 46202, USA.
Markand
O
O
Worth
R
R
Smith
R
R
Wellman
H
H
Hutchins
G
G
Park
H
H
Ghetti
B
B
Azzarelli
B
B
D000293:Adolescent; D000328:Adult; D000654:Amobarbital; D001284:Atrophy / Q000175:diagnosis; D002343:Carotid Artery, Internal; D002648:Child; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D006993:Hypnotics and Sedatives; D007269:Injections, Intra-Arterial; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D012598:Sclerosis / Q000175:diagnosis; D003294:Seizures, Febrile / Q000150:complications*; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D014055:Tomography, Emission-Computed / Q000592:standards*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D000654:Amobarbital