Assessment of Presurgical 18 FDG PET-CT Metabolic Patterns and Postsurgical Seizure Outcome in Temporal Lobe Epilepsy
Jimena Colado-Martinez1, Pilar Robles-Lomelin2, Jimena Gonzalez Salido1, Irving Fuentes-Calvo1, Luis A. Marin-Castañeda3, Fernando Vasquez-Lopez1, Betsy C. Vázquez-Cruz1, Eithel A. Valenzuela-Mendívil1, Mijail A. Rivas-Cruz1, Nora Kerik-Rotenberg4, Salvador Martínez-Medina2, Mario A. Sebastián-Díaz7, Alfonso Arellano-Reynoso5, Guillermo Axayacalt Gutiérrez-Aceves6, Iris E. Martínez-Juárez1
1Epilepsy Clinic, Epilepsy Clinic & Clinical Epileptology Fellowship, National Institute of Neurology and Neurosurgery “Manuel Velasco Suarez” (NINNMVS) & Faculty of Medicine, UNAM, Mexico City and Clinical Epileptology Fellowship NINNMVS/UNAM, 2Neurology Residency, 3Department of Neurophysiology, 4Molecular Imaging Unit,, 5Functional Neurosurgery Department, 6Neurosurgery Department, National Institute of Neurology and Neurosurgery. Mexico City, Mexico., 7Neurology Department, South Central High Specialty Hospital PEMEX, Mexico City, Mexico.
Objective:
To describe presurgical brain metabolic changes using 18-FDG PET/CT in patients with temporal lobe epilepsy (TLE) and evaluate their postsurgical seizure outcomes.
Background:
TLE is the most common type of drug-resistant epilepsy in adults, particularly in cases of mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS), and is surgically remediable.
Design/Methods:
A retrospective, longitudinal cohort was conducted, including patients from the Epilepsy Clinic at a Neurology Center in Mexico between 2017-2024. Patients MTLE-HS and underwent temporal lobectomy. Data were acquired in SPSS®v25. Quantitative variables were summarized as mean, and standard deviation and analyzed with Student's t-test our Mann-Whitney U. Qualitative variables were expressed as frequencies and percentages and analyzed using Pearson's Chi-square or Fisher's exact tests. Concordant PET was defined as the presence of hypometabolism restricted to the affected TLE, and non-concordant PET when normal or with hypometabolism was in the affected TLE but included metabolic changes in other brain regions.
Results:
Thirty patients were included, 14 (46.7%) were female, mean age at epilepsy onset was 11± 7.3 (1–30) years, mean age of 43 ± 8.49 years. The most common surgical procedure was amygdalohippocampectomy (AHC) plus temporal lobectomy in 18 (60%) patients, followed by AHC alone in 7 (23.3%) and temporal lobectomy in 3 (10%).Twenty (66.7%) patients had concordant 18-FDG PET-CT, and 8 (26.7%) were non-concordant. There was no statistically significant difference in seizure freedom at two years among both groups. At follow-up in the concordant group, 18 patients (90%) achieved Engel class I, and in the non-concordant group, 5 (62.5 %) achieved class I (p=0.203).
Conclusions:
The 18-FDG PET-CT scan is a valuable tool for evaluating the epileptogenic zone in surgical candidates. However, concordance was not a significant predictor of outcomes in well-selected patients, highlighting the importance of proper patient selection over-reliance on this tool alone.
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