Metabolic scoring in autoimmune epilepsy—Should APE scores be modified?
| Autor: | Bhargavi Ramanujam, Arun Raj Sreedharan Thankarajan, Rajesh Kumar Singh, Ela Varsi, Chandrasekhar Bal, Deepti Vibha, Manjari Tripathi, Ajay Garg, Kavish Ihtisham, Madhavi Tripathi |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Scoring system Adolescent Mri negative Autoimmune Diseases Young Adult 03 medical and health sciences Epilepsy 0302 clinical medicine Metabolic Diseases Fluorodeoxyglucose F18 Antibody negative medicine Humans 030212 general & internal medicine Child Antibody prevalence Prospective cohort study Aged Retrospective Studies Aged 80 and over business.industry General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging Functional imaging Autoimmune epilepsy Neurology Child Preschool Positron-Emission Tomography Female Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | Acta Neurologica Scandinavica. 143:13-18 |
| ISSN: | 1600-0404 0001-6314 |
| DOI: | 10.1111/ane.13346 |
| Popis: | Objective We evaluate the potential utility of F-18 FDG PET in addition to MRI in the diagnostic work-up of patients with autoimmune epilepsy (AE) and propose the inclusion of functional imaging in the antibody prevalence in epilepsy (APE) scoring system. Methods This was a retrospective analysis in 60 patients, diagnosed and treated for AE, of whom 40 were antibody negative (presumed AE) and 20 were antibody positive (definitive AE). All patients had undergone a dedicated brain and whole body FDG-PET in the department of Nuclear Medicine. Results In the antibody negative group, MRI supported a diagnosis of AE in 23 patients. Both MRI and PET were indicative in 12 cases, and standalone PET was positive in 8. While MRI alone was diagnostic in 57% (23/40), the combined yield of both modalities was 77% (31/40). When PET scores were added to assign the APE score in MRI negative cases, average APE score was 5.4. In the antibody positive group, MRI supported the diagnosis of AE in 7 patients. Both MRI and PET were positive in 4 patients and standalone PET was positive in 5 patients. While MRI alone was diagnostic in 35% (7/20), the combined yield of both modalities was 60 % (12/20). When PET scores were added to assign the APE score in MRI negative cases, average APE score was 6.1. Conclusion The inclusion of metabolic information from PET distinctly improved (the sensitivity of) APE scores to predict autoimmune origin even in antibody negative cases. A larger prospective study of similar type could justify adoption of FDG PET into the standard diagnostic procedure. |
| Databáze: | OpenAIRE |
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