Presurgical evaluation for partial epilepsy
Autor: | Thomas R. Henry, M. F. Levesque, M. E. Phelps, William W. Sutherling, John C. Mazziotta, M. W. Risinger, Jerome Engel |
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Rok vydání: | 1990 |
Předmět: |
Adult
Male Fluorine Radioisotopes Adolescent medicine.medical_treatment Deoxyglucose Electroencephalography Stereoelectroencephalography Temporal lobe Stereotaxic Techniques Epilepsy Fluorodeoxyglucose F18 Predictive Value of Tests Preoperative Care Sphenoid Bone Humans Medicine Ictal Child Anterior temporal lobectomy Retrospective Studies Scalp medicine.diagnostic_test business.industry Brain Middle Aged medicine.disease Electrodes Implanted medicine.anatomical_structure Stereotaxic technique Female Epilepsies Partial Neurology (clinical) business Nuclear medicine Tomography Emission-Computed |
Zdroj: | Neurology. 40:1670-1670 |
ISSN: | 1526-632X 0028-3878 |
DOI: | 10.1212/wnl.40.11.1670 |
Popis: | 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 hypo-metabolic 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. |
Databáze: | OpenAIRE |
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