title: Prognostic Role of Functional Neuroimaging after Multilobar Resection in Patients with Localization-Related Epilepsy.
abstract: To investigate the usage of functional neuroimaging as a prognostic tool for seizure recurrence and long-term outcomes in patients with multilobar resection, we recruited 90 patients who received multilobar resections between 1995 and 2013 with at least 1-year follow-up (mean 8.0 years). All patients were monitored using intracranial electroencephalography (EEG) after pre-surgical evaluation. Clinical data (demographics, electrophysiology, and neuroimaging) were reviewed retrospectively. Surgical outcomes were evaluated at 1, 2, 5 years after surgery, and at the end of the study. After 1 year, 56 patients (62.2%) became Engel class I and at the last follow-up, 47 patients (52.2%) remained seizure-free. Furthermore, non-localized 18F-fluorodeoxyglucose positron emission tomography (PET), identifying hypometabolic areas not concordant with ictal onset zones, significantly correlated with seizure recurrence after 1 year. Non-lesional magnetic resonance imaging (MRI) and left-sided resection correlated with poor outcomes. In the last follow-up, non-localized PET and left-sided resection significantly correlated with seizure recurrence. Both localized PET and ictal-interictal SPECT subtraction co-registered to MR (SISCOM) predicted good surgical outcomes in the last follow-up (69.2%, Engel I). This study suggests that PET and SISCOM may predict postoperative outcomes for patients after multilobar epilepsy and shows comparable long-term surgical outcomes after multilobar resection.
authors: Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience center, Samsung Medical Center, Seoul, South Korea.
authors: Eun Bin
authors: EB
authors: Cho
authors: Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience center, Samsung Medical Center, Seoul, South Korea.
authors: Eun Yeon
authors: EY
authors: Joo
authors: Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience center, Samsung Medical Center, Seoul, South Korea.
authors: Dae-Won
authors: DW
authors: Seo
authors: Department of Neurosurgery, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Seung-Chyul
authors: SC
authors: Hong
authors: Department of Neurology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience center, Samsung Medical Center, Seoul, South Korea.
authors: Seung Bong
authors: SB
authors: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D049268:Positron-Emission Tomography; D011859:Radiography; D012640:Seizures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
chemical_list: D019788:Fluorodeoxyglucose F18