Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/20085
Title: Metabolic patterns and seizure outcomes following anterior temporal lobectomy.
Authors: Cahill, Varduhi;Sinclair, Benjamin;Malpas, Charles B;McIntosh, Anne M;Chen, Zhibin;Vivash, Lucy E;O'Shea, Marie F;Wilson, Sarah J;Desmond, Patricia M;Berlangieri, Salvatore U;Hicks, Rodney J;Rowe, Christopher C;Morokoff, Andrew P;King, James A;Fabinyi, Gavin C;Kaye, Andrew H;Kwan, Patrick;Berkovic, Samuel F;O'Brien, Terence J
Affiliation: Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, United Kingdom
Departments of Medicine and Radiology, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
Murdoch Children's Research Institute, Melbourne, Victoria, Australia
Departments of Medicine and Neurology, Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Departments of Neuroscience and Neurology, Alfred Health, Central Clinical School, Monash University, Melbourne, Victoria, Australia
Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Comprehensive Epilepsy Program, Austin Health, Heidelberg, Victoria, Australia
Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Peter MacCallum Cancer Centre and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
Issue Date: 4-Jan-2019
EDate: 2019
Citation: Annals of neurology 2019; online first: 4 January
Abstract: We investigated the relationship between the interictal metabolic patterns, the extent of resection of 18 F-fluorodeoxyglucose positron emission tomography (18 FDG-PET) hypometabolism, and seizure outcomes in patients with unilateral drug-resistant mesial temporal lobe epilepsy (MTLE) following anterior temporal lobe (TL) resection. Eighty-two patients with hippocampal sclerosis or normal magnetic resonance imaging (MRI) findings, concordant 18 FDG-PET hypometabolism, and at least 2 years of postoperative follow-up were included in this 2-center study. The hypometabolic regions in each patient were identified with reference to 20 healthy controls (p < 0.005). The resected TL volume and the volume of resected TL PET hypometabolism (TLH) were calculated from the pre- and postoperative MRI scans coregistered with interictal 18 FDG-PET. Striking differences in metabolic patterns were observed depending on the lateralization of the epileptogenic TL. The extent of the ipsilateral TLH was significantly greater in left MTLE patients (p < 0.001), whereas right MTLE patients had significantly higher rates of contralateral (CTL) TLH (p = 0.016). In right MTLE patients, CTL hypometabolism was the strongest predictor of an unfavorable seizure outcome, associated with a 5-fold increase in the likelihood of seizure recurrence (odds ratio [OR] = 4.90, 95% confidence interval [CI] = 1.07-22.39, p = 0.04). In left MTLE patients, greater extent of resection of ipsilateral TLH was associated with lower rates of seizure recurrence (p = 0.004) in univariate analysis; however, its predictive value did not reach statistical significance (OR = 0.96, 95% CI = 0.90-1.02, p = 0.19). The difference in metabolic patterns depending on the lateralization of MTLE may represent distinct epileptic networks in patients with right versus left MTLE, and can guide preoperative counseling and surgical planning. Ann Neurol 2019; 1-10.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20085
DOI: 10.1002/ana.25405
ORCID: 0000-0003-4580-841X
0000-0003-3910-2453
PubMed URL: 30609109
Type: Journal Article
Appears in Collections:Journal articles

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