Presurgical evaluation for partial epilepsy: Relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG

Journal Article · Thu Nov 01 00:00:00 EST 1990 · Neurology; (USA)

DOI:https://doi.org/10.1212/WNL.40.11.1670· OSTI ID:6070841

Engel, J Jr; Henry, T R; Risinger, M W; Mazziotta, J C; Sutherling, W W; Levesque, M F; Phelps, M E

One hundred fifty-three patients with medically refractory partial epilepsy underwent chronic stereotactic depth-electrode EEG (SEEG) evaluations after being studied by positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and scalp-sphenoidal EEG telemetry. We carried out retrospective standardized reviews of local cerebral metabolism and scalp-sphenoidal ictal onsets to determine when SEEG recordings revealed additional useful information. FDG-PET localization was misleading in only 3 patients with temporal lobe SEEG ictal onsets for whom extratemporal or contralateral hypometabolism could be attributed to obvious nonepileptic structural defects. Two patients with predominantly temporal hypometabolism may have had frontal epileptogenic regions, but ultimate localization remains uncertain. Scalp-sphenoidal ictal onsets were misleading in 5 patients. For 37 patients with congruent focal scalp-sphenoidal ictal onsets and temporal hypometabolic zones, SEEG recordings never demonstrated extratemporal or contralateral epileptogenic regions; however, 3 of these patients had nondiagnostic SEEG evaluations. The results of subsequent subdural grid recordings indicated that at least 1 of these patients may have been denied beneficial surgery as a result of an equivocal SEEG evaluation. Weighing risks and benefits, it is concluded that anterior temporal lobectomy is justified without chronic intracranial recording when specific criteria for focal scalp-sphenoidal ictal EEG onsets are met, localized hypometabolism predominantly involves the same temporal lobe, and no other conflicting information has been obtained from additional tests of focal functional deficit, structural imaging, or seizure semiology.

• OSTI ID: 6070841
• Journal Information: Neurology; (USA), Vol. 40:11; ISSN 0028-3878
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
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IMAGE PROCESSING
EPILEPSY
DIAGNOSIS
COMPARATIVE EVALUATIONS
DIAGNOSTIC TECHNIQUES
FLUORINE 18
GLUCOSE
METABOLISM
PATIENTS
POSITRON COMPUTED TOMOGRAPHY
SURGERY
ALDEHYDES
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COMPUTERIZED TOMOGRAPHY
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FLUORINE ISOTOPES
HEXOSES
HOURS LIVING RADIOISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
LIGHT NUCLEI
MEDICINE
MONOSACCHARIDES
NERVOUS SYSTEM
NERVOUS SYSTEM DISEASES
NUCLEI
ODD-ODD NUCLEI
ORGANIC COMPOUNDS
ORGANS
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RADIOISOTOPES
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