| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From Neuroradiology (N.S., J. Kung, S.J.S., J. Koo), Pediatric Neurology (S.K., J.Y.W., J.T.L., R.S., W.D.S.), Neurology (R.S., W.D.S., J.E., H.V.V.), Neuropathology (H.M., W.H.Y., H.V.V.), Neurosurgery (I.F., G.W.M.), Neurobiology (J.E.), Psychiatry and Behavioral Sciences (J.E.), The Brain Research Institute (J.E., W.H.Y., H.V.V., G.W.M.), and The Mental Retardation Research Center (H.V.V., G.W.M.), David Geffen School of Medicine, University of California, Los Angeles, CA.
Address correspondence and reprint requests to Dr. Gary W. Mathern, Reed Neurological Research Center, 710 Westwood Plaza, Room 2123, Los Angeles, CA 90095-1769 gmathern{at}ucla.edu
Objective: Patients with cortical dysplasia (CD) are difficult to treat because the MRI abnormality may be undetectable. This study determined whether fluorodeoxyglucose (FDG)-PET/MRI coregistration enhanced the recognition of CD in epilepsy surgery patients.
Methods: Patients from 2004–2007 in whom FDG-PET/MRI coregistration was a component of the presurgical evaluation were compared with patients from 2000–2003 without this technique. For the 2004–2007 cohort, neuroimaging and clinical variables were compared between patients with mild Palmini type I and severe Palmini type II CD.
Results: Compared with the 2000–2003 cohort, from 2004–2007 more CD patients were detected, most had type I CD, and fewer cases required intracranial electrodes. From 2004–2007, 85% of type I CD cases had normal non–University of California, Los Angeles (UCLA) MRI scans. UCLA MRI identified CD in 78% of patients, and 37% of type I CD cases had normal UCLA scans. EEG and neuroimaging findings were concordant in 52% of type I CD patients, compared with 89% of type II CD patients. FDG-PET scans were positive in 71% of CD cases, and type I CD patients had less hypometabolism compared with type II CD patients. Postoperative seizure freedom occurred in 82% of patients, without differences between type I and type II CD cases.
Conclusions: Incorporating fluorodeoxyglucose-PET/MRI coregistration into the multimodality presurgical evaluation enhanced the noninvasive identification and successful surgical treatment of patients with cortical dysplasia (CD), especially for the 33% of patients with nonconcordant findings and those with normal MRI scans from mild type I CD.
GLOSSARY: AED = antiepileptic drug; CD = cortical dysplasia; FDG = fluorodeoxyglucose; mMCD = mild malformations of cortical development; TLE = temporal lobe epilepsy; UCLA = University of California, Los Angeles.
Received April 28, 2008. Accepted in final form August 8, 2008.
Supplemental data at www.neurology.org
This study was supported in part by NIH grants R01 NS38992 and P05 NS02808 to G.W.M. and J.E. H.M. was supported by grants-in-aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (17689040) and the Japan Epilepsy Research Foundation (H16-009).
Disclosure: The authors report no disclosures.
This article has been cited by other articles:
|
|
 |
|
  K.K. Lee and N. Salamon [18F] Fluorodeoxyglucose-Positron-Emission Tomography and MR Imaging Coregistration for Presurgical Evaluation of Medically Refractory Epilepsy AJNR Am. J. Neuroradiol., November 1, 2009; 30(10): 1811 - 1816. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Berg, G. W. Mathern, R. A. Bronen, R. K. Fulbright, F. DiMario, F. M. Testa, and S. R. Levy Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy Brain, October 1, 2009; 132(10): 2785 - 2797. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
