title: 18F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy.
abstract: OBJECTIVE
  To search for [18F]-fluorodeoxyglucose (FDG)-PET patterns predictive of long-term prognosis in surgery for drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS).
  
  
  METHODS
  We analyzed metabolic data with [18F]-FDG-PET in 97 patients with MTLE (53 female participants; age range 15-56 years) with unilateral HS (50 left) and compared the metabolic patterns, electroclinical features, and structural atrophy on MRI in patients with the best outcome after anteromesial temporal resection (Engel class IA, completely seizure-free) to those with a non-IA outcome, including suboptimal outcome and failure. Imaging processing was performed with statistical parametric mapping (SPM5).
  
  
  RESULTS
  With a mean follow-up of >6 years (range 2-14 years), 85% of patients achieved a class I outcome, including 45% in class IA. Class IA outcome was associated with a focal anteromesial temporal hypometabolism, whereas non-IA outcome correlated with extratemporal metabolic changes that differed according to the lateralization: ipsilateral mesial frontal and perisylvian hypometabolism in right HS and contralateral fronto-insular hypometabolism and posterior white matter hypermetabolism in left HS. Suboptimal outcome presented a metabolic pattern similar to the best outcome but with a larger involvement of extratemporal areas, including the contralateral side in left HS. Failure was characterized by a mild temporal involvement sparing the hippocampus and relatively high extratemporal hypometabolism on both sides. These findings were concordant with electroclinical features reflecting the organization of the epileptogenic zone but were independent of the structural abnormalities detected on MRI.
  
  
  CONCLUSIONS
  [18F]-FDG-PET patterns help refine the prognostic factors in MTLE and should be implemented in predictive models for epilepsy surgery.
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France. f.chassoux@ch-sainte-anne.fr.
authors.forename: Francine
authors.initials: F
authors.lastname: Chassoux
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Artiges
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Semah
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Agathe
authors.initials: A
authors.lastname: Laurent
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Landré
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Baris
authors.initials: B
authors.lastname: Turak
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gervais
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Badia-Ourkia
authors.initials: BO
authors.lastname: Helal
authors.affiliation: From the Department of Neurosurgery (F.C., A.L., E.L., B.T., B.D.), Sainte-Anne Hospital; Paris-Descartes University (F.C., A.L., E.L., B.T., B.D.); INSERM UMR 1129 (F.C., A.L.), Paris; Nuclear Medicine Department (F.C., P.G., B.-O.H.), SHFJ, CEA/SAC/DRF/IBM Neurospin Gif/Yvette; INSERM (E.A.), Research Unit 1000 "Neuroimaging and Psychiatry," Paris Sud University-Paris Saclay University; Psychiatry Department 91G16 (E.A.), Orsay Hospital, Orsay; Department of Nuclear Medicine and INSERM U 1171 (F.S.), CHU Lille; and INSERM U 1023 (P.G., B.-O.H.), IMIV, CEA, Paris-Sud University, Orsay, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Devaux
mesh_terms: D000293:Adolescent; D000328:Adult; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism*; D006624:Hippocampus / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D049268:Positron-Emission Tomography; D011184:Postoperative Period; D012598:Sclerosis / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18