Cerebral Metabolism and Personality in Patients with Epilepsy of the Temporal Lobe

2006 ◽  
Vol 28 (1) ◽  
pp. 3-15 ◽  
Author(s):  
J. de Felipe-Oroquieta ◽  
F. Ortega ◽  
A. Maldonado ◽  
M. A. Pozo ◽  
R. G. Sola
Keyword(s):  
Temporal Lobe ◽  
Fdg Pet ◽  
Cerebral Metabolism ◽  
Rorschach Test ◽  
Personality Style ◽  
Complex Partial Seizures ◽  
Opposite Pattern ◽  
Metabolic Pattern ◽  
Personality Styles ◽  
Positron Emission

Extratension and introversion are stable personality styles in adult subjects. Mental functioning of the former is especially influenced by the emotions and of the latter by ideation. The aim of the present work is to analyze, using positron emission tomography with [18F]fluorodeoxyglucose (18FDG-PET), possible differences in cerebral metabolism in patients with intractable temporal lobe epilepsy (TLE) in relation to different personality styles assessed with the Rorschach test. Twenty-eight drug-resistant TLE patients with complex partial seizures were assessed by means of FDG-PET and the Rorschach test. According to location of the epileptogenic area in the dominant hemisphere and the personality style of the subject, a table of contingencies was drawn up (χ² and contingency coefficient). Finally, an analysis was made of the personality changes in patients that had received neurosurgical treatment. The results show a clear differentiation with FDG-PET as regards location of the temporal lobe affected. In 80% of subjects personality style coincided with a cerebral metabolic pattern: introversives had predominant hypometabolism in the left hemisphere and extratensives in the right. The tendency toward introversion or extratension in ambitents showed this metabolic pattern only in 38% of subjects, with 54% presenting the opposite pattern. The Rorschach test was carried out for a second time after surgical temporal resection (n = 13), and it was observed that some patients maintained their personality style while others modified it. These results suggest the existence of different hemispheric metabolic patterns in the personality styles assessed by the Rorschach test in TLE patients.

scholarly journals Quantifying Interictal Metabolic Activity in Human Temporal Lobe Epilepsy

1990 ◽  
Vol 10 (5) ◽  
pp. 748-757 ◽  
Author(s):  
Thomas R. Henry ◽  
John C. Mazziotta ◽  
Jerome Engel ◽  
Peter D. Christenson ◽  
Jing Xi Zhang ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Normal Brain ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Anatomical Analysis ◽  
Positron Emission ◽  
Human Temporal Lobe

The majority of patients with complex partial seizures of unilateral temporal lobe origin have interictal temporal hypometabolism on [18F]fluorodeoxyglucose positron emission tomography (FDG PET) studies. Often, this hypometabolism extends to ipsilateral extratemporal sites. The use of accurately quantified metabolic data has been limited by the absence of an equally reliable method of anatomical analysis of PET images. We developed a standardized method for visual placement of anatomically configured regions of interest on FDG PET studies, which is particularly adapted to the widespread, asymmetric, and often severe interictal metabolic alterations of temporal lobe epilepsy. This method was applied by a single investigator, who was blind to the identity of subjects, to 10 normal control and 25 interictal temporal lobe epilepsy studies. All subjects had normal brain anatomical volumes on structural neuroimaging studies. The results demonstrate ipsilateral thalamic and temporal lobe involvement in the interictal hypometabolism of unilateral temporal lobe epilepsy. Ipsilateral frontal, parietal, and basal ganglial metabolism is also reduced, although not as markedly as is temporal and thalamic metabolism.

Cerebral Metabolism during Propofol Anesthesia in Humans Studied with Positron Emission Tomography 

1995 ◽  
Vol 82 (2) ◽  
pp. 393-403 ◽  
Author(s):  
Michael T. Alkire ◽  
Richard J. Haier ◽  
Steven J. Barker ◽  
Nitin K. Shah ◽  
Joseph C. Wu ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Animal Studies ◽  
Cerebral Metabolism ◽  
Anterior Cingulate ◽  
Emission Tomography ◽  
Whole Brain ◽  
Metabolic Pattern ◽  
Positron Emission ◽  
Cortical Regions

Background Although the effects of propofol on cerebral metabolism have been studied in animals, these effects have yet to be directly examined in humans. Consequently, we used positron emission tomography (PET) to demonstrate in vivo the regional cerebral metabolic changes that occur in humans during propofol anesthesia. Methods Six volunteers each underwent two PET scans; one scan assessed awake-baseline metabolism, and the other assessed metabolism during anesthesia with a propofol infusion titrated to the point of unresponsiveness (mean rate +/- SD = 7.8 +/- 1.5 mg.kg-1.h-1). Scans were obtained using the 18fluorodeoxyglucose technique. Results Awake whole-brain glucose metabolic rates (GMR) averaged 29 +/- 8 mumoles.100 g-1.min-1 (mean +/- SD). Anesthetized whole-brain GMR averaged 13 +/- 4 mumoles.100 g-1.min-1 (paired t test, P < or = 0.007). GMR decreased in all measured areas during anesthesia. However, the decrease in GMR was not uniform. Cortical metabolism was depressed 58%, whereas subcortical metabolism was depressed 48% (P < or = 0.001). Marked differences within cortical regions also occurred. In the medial and subcortical regions, the largest percent decreases occurred in the left anterior cingulate and the inferior colliculus. Conclusion Propofol produced a global metabolic depression on the human central nervous system. The metabolic pattern evident during anesthesia was reproducible and differed from that seen in the awake condition. These findings are consistent with those from previous animal studies and suggest PET may be useful for investigating the mechanisms of anesthesia in humans.

scholarly journals Subcortical Hypermetabolism Associated With Cortical Hypometabolism Is a Common Metabolic Pattern in Patients With Anti-Leucine-Rich Glioma-Inactivated 1 Antibody Encephalitis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaobin Zhao ◽  
Shaokun Zhao ◽  
Yaojing Chen ◽  
Zhanjun Zhang ◽  
Xiaotong Li ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Parietal Lobe ◽  
Statistical Parametric Mapping ◽  
Occipital Lobe ◽  
Healthy Controls ◽  
Metabolic Pattern ◽  
Individual Level ◽  
Positron Emission ◽  
Neurologic Disability ◽  
The Individual

PurposeBrain 18F-fluorodeoxyglucose positron emission tomography (FDG PET) is a sensitive technique for assisting in the diagnosis of patients with anti-leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis. However, the common pattern of this disorder assessed by FDG PET remains unknown. The present study aimed to explore the glucose metabolic patterns of this disorder based on PET voxel analysis.MethodsThis retrospective study enrolled 25 patients with anti-LGI1 encephalitis, who were admitted in Beijing Tiantan Hospital between September 2014 and July 2019. The glucose metabolic pattern was compared between the included patients and 44 age- and gender-matched healthy controls using Statistical Parametric Mapping. Then, the correlation between the metabolic pattern and scaled activities of daily living (ADLs) of the patients was assessed.ResultsThe median time from symptom onset to PET scans was 9 w (range:2-53w). The groupwise analysis revealed that patients with anti-LGI1 encephalitis had left hippocampal hypermetabolism and hypometabolism in almost all neocortical regions. The individual-level results showed most patients presented a decreased metabolism in neocortical regions, as well as an increase in metabolism in the hippocampus and basal ganglia. Furthermore, the metabolic gradient between hippocampus and neocortical regions was positively associated with the ADLs (frontal lobe, r=0.529, P=0.008; parietal lobe, r=0.474, P=0.019; occipital lobe, r=0.413, P=0.045; temporal lobe, r=0.490, P=0.015), respectively. In addition, the patients with facio-brachial dystonic seizures (FBDS) presented bilateral putamen hypermetabolism, when compared to patients without FBDS and healthy controls.ConclusionSubcortical hypermetabolism associated with cortical hypometabolism presented with a common metabolic pattern in patients with anti-LGI1 encephalitis in the present study. The resolution of the metabolic gradient of the hippocampal hypermetabolism and neocortical hypometabolism may bring about improved clinical neurologic disability.

scholarly journals [18F]-Fluoro-Deoxy-Glucose Positron Emission Tomography Scan Should Be Obtained Early in Cases of Autoimmune Encephalitis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
C. R. Newey ◽  
A. Sarwal ◽  
S. Hantus
Keyword(s):  
Positron Emission Tomography ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Brain Mri ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Altered Mental Status ◽  
Emission Tomography ◽  
Positron Emission ◽  
Mesial Temporal Lobe

Introduction. Autoimmune encephalitis (AE) is a clinically challenging diagnosis with nonspecific neurological symptoms. Prompt diagnosis is important and often relies on neuroimaging. We present a case series of AE highlighting the importance of an early [18F]-fluoro-deoxy-glucose positron emission tomography (FDG-PET) scan.Methods. Retrospective review of seven consecutive cases of autoimmune encephalitis.Results. All patients had both magnetic resonance imaging (MRI) and FDG-PET scans. Initial clinical presentations included altered mental status and/or new onset seizures. Six cases had serum voltage-gated potassium channel (VGKC) antibody and one had serum N-methyl-D-aspartate (NMDA) antibody. MRI of brain showed mesial temporal lobe hyperintensity in five cases of VGKC. The other two patients with VGKC or NMDA AE had restiform body hyperintensity on MRI brain or a normal MRI, respectively. Mesial temporal lobe hypermetabolism was noted in three cases on FDG-PET, despite initial unremarkable MRI. Malignancy workup was negative in all patients.Conclusion. A high index of suspicion for AE should be maintained in patients presenting with cognitive symptoms, seizures, and limbic changes on neuroimaging. In cases with normal initial brain MRI, FDG-PET can be positive. Additionally, extralimbic hyperintensity on MRI may also be observed.

18F-FDG-PET patterns of surgical success and failure in mesial temporal lobe epilepsy

Neurology ◽  
2017 ◽  
Vol 88 (11) ◽  
pp. 1045-1053 ◽  
Author(s):  
Francine Chassoux ◽  
Eric Artiges ◽  
Franck Semah ◽  
Agathe Laurent ◽  
Elisabeth Landré ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Hippocampal Sclerosis ◽  
Statistical Parametric Mapping ◽  
Mesial Temporal Lobe Epilepsy ◽  
Epileptogenic Zone ◽  
Metabolic Pattern ◽  
Suboptimal Outcome ◽  
Mesial Temporal Lobe

Objective:To search for [18F]-fluorodeoxyglucose (FDG)-PET patterns predictive of long-term prognosis in surgery for drug-resistant mesial temporal lobe epilepsy (MTLE) due to hippocampal sclerosis (HS).Methods:We analyzed metabolic data with [18F]-FDG-PET in 97 patients with MTLE (53 female participants; age range 15–56 years) with unilateral HS (50 left) and compared the metabolic patterns, electroclinical features, and structural atrophy on MRI in patients with the best outcome after anteromesial temporal resection (Engel class IA, completely seizure-free) to those with a non-IA outcome, including suboptimal outcome and failure. Imaging processing was performed with statistical parametric mapping (SPM5).Results:With a mean follow-up of >6 years (range 2–14 years), 85% of patients achieved a class I outcome, including 45% in class IA. Class IA outcome was associated with a focal anteromesial temporal hypometabolism, whereas non-IA outcome correlated with extratemporal metabolic changes that differed according to the lateralization: ipsilateral mesial frontal and perisylvian hypometabolism in right HS and contralateral fronto-insular hypometabolism and posterior white matter hypermetabolism in left HS. Suboptimal outcome presented a metabolic pattern similar to the best outcome but with a larger involvement of extratemporal areas, including the contralateral side in left HS. Failure was characterized by a mild temporal involvement sparing the hippocampus and relatively high extratemporal hypometabolism on both sides. These findings were concordant with electroclinical features reflecting the organization of the epileptogenic zone but were independent of the structural abnormalities detected on MRI.Conclusions:[18F]-FDG-PET patterns help refine the prognostic factors in MTLE and should be implemented in predictive models for epilepsy surgery.

FLUORODEOXYGLUCOSE–POSITRON EMISSION TOMOGRAPHIC IMAGING FOR THE DIAGNOSIS OF MESIAL TEMPORAL LOBE EPILEPSY

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1130-1138 ◽  
Author(s):  
Warren W. Boling ◽  
Melissa Lancaster ◽  
Michal Kraszpulski ◽  
Adriana Palade ◽  
Gary Marano ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Visual Inspection ◽  
Mesial Temporal Lobe Epilepsy ◽  
Positron Emission Tomographic ◽  
Positron Emission ◽  
Mri Volumetry ◽  
Mesial Temporal Lobe

Abstract OBJECTIVE Fluorodeoxyglucose (FDG)-positron emission tomographic (PET) imaging plays an important role in the evaluation of intractable epilepsy. The metabolic defect has proven utility in the lateralization of temporal lobe epilepsy. However, the role of FDG–PET imaging in the localization of a seizure focus within the temporal lobe is uncertain. We evaluated FDG–PET imaging for the capability to localize a temporal seizure focus within the mesial structures. METHODS Twenty-eight patients who underwent selective amygdalohippocampectomy for intractable temporal lobe epilepsy were studied. Patients were divided into 2 groups: those who were free of seizures (FS) and those with persisting seizures postoperatively. FS patients were defined by having mesial temporal lobe epilepsy (MTLE). Preoperative FDG–PET activity was evaluated in temporal lobe structures and contrasted with magnetic resonance imaging (MRI) for usefulness in identifying MTLE in an individual. RESULTS Pathology of the hippocampus revealed mesial temporal sclerosis in all but 1 patient. Qualitative visual inspection of the MRI scan was not reliable in the identification of MTLE (P = 0.15). MRI volumetry found smaller mesial temporal structures (P = 0.04) in FS patients. Mesial temporal metabolic activity was reduced in the FS group (hippocampus, P = 0.001). However, a combination of imaging modalities was found to be the best predictor of MTLE. PET imaging plus MRI qualitative inspection identified all patients with and without MTLE correctly and was superior to MRI alone (P = 0.01 and P = 0.02, respectively). CONCLUSION MRI volumetry and PET imaging were comparable (P = 0.73) and able to identify MTLE in most patients, but a combination of PET imaging and MRI visual inspection was superior in the recognition of MTLE.

scholarly journals FDG-PET Profiles of Extratemporal Metabolism as a Predictor of Surgical Failure in Temporal Lobe Epilepsy

2020 ◽  
Vol 7 ◽  
Author(s):  
Yongxiang Tang ◽  
Guang Liao ◽  
Jian Li ◽  
Tingting Long ◽  
Yulai Li ◽  
...  
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Cerebral Metabolism ◽  
Statistical Parametric Mapping ◽  
Class I ◽  
Metabolic Profiles ◽  
Metabolic Abnormalities ◽  
Abnormal Metabolism ◽  
Surgical Failure

Objective: Metabolic abnormality in the extratemporal area on fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is not an uncommon finding in drug-resistant temporal lobe epilepsy (TLE), however the correlation between extratemporal metabolic abnormalities and surgical long-term prognosis has not been fully elucidated. We aim to investigate FDG-PET extratemporal metabolic profiles predictive of failure in surgery for TLE patients.Methods: Eighty-two patients with unilateral TLE (48 female, 34 male; 25.6 ± 10.6 years old; 37 left TLE, 45 right TLE) and 30 healthy age-matched controls were enrolled. Patients were classified either as experiencing seizure-recurrence (SZR, Engel class II through IV) or seizure-free (SZF, Engel class I) at least 1 year after surgery. Regional cerebral metabolism was evaluated by FDG-PET with statistical parametric mapping (SPM12). Abnormal metabolic profiles and patterns on FDG-PET in SZR group were evaluated and compared with those of healthy control and SZF subjects on SPM12. Volume and intensity as well as special brain areas of abnormal metabolism in temporal and extratemporal regions were quantified and visualized.Results: With a median follow-up of 1.5 years, 60% of patients achieved Engel class I (SZF). SZR was associated with left TLE and widespread hypometabolism in FDG-PET visual assessment (both p < 0.05). All patients had hypometabolism in the ipsilateral temporal lobe but SZR was not correlated with volume or intensity of temporal hypometabolism (median, 1,456 vs. 1,040 mm3; p > 0.05). SZR was correlated with extratemporal metabolic abnormalities that differed according to lateralization: in right TLE, SZR exhibited larger volume in extratemporal areas compared to SZF (median, 11,060 vs. 2,112 mm3; p < 0.05). Surgical failure was characterized by Cingulum_Ant_R/L, Frontal_Inf_Orb_R abnormal metabolism in extratemporal regions. In left TLE, SZR presented a larger involvement of extratemporal areas similar to right TLE but with no significant (median, 5,873 vs. 3,464 mm3; p > 0.05), Cingulum_Ant_ R/L, Parietal_Inf_L, Postcentral_L, and Precuneus_R involved metabolic abnormalities were correlated with SZR.Conclusions: Extratemporal metabolic profiles detected by FDG-PET may indicate a prominent cause of TLE surgery failure and should be considered in predictive models for epilepsy surgery. Seizure control after surgery might be improved by investigating extratemporal areas as candidates for resection or neuromodulation.

scholarly journals PET Scanning in Partial Epilepsy

1991 ◽  
Vol 18 (S4) ◽  
pp. 588-592 ◽  
Author(s):  
Jerome Engel
Keyword(s):  
Fdg Pet ◽  
Single Photon ◽  
Photon Emission ◽  
Biologically Active ◽  
Emission Computed Tomography ◽  
Supporting Evidence ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
Positron Emission ◽  
Pet Scanning

ABSTRACT:Many biologically active tracers are available for positron emission tomography (PET) investigations, but most studies of epilepsy have utilized l8F-fluorodeoxyglucose (FDG) to measure local cerebral metabolic rate for glucose. Over 70% of patients with medically refractory partial seizures demonstrate an interictal zone of hypometabolism corresponding to the epileptogenic region. This metabolic defect commonly involves the temporal lobe in patients with complex partial seizures of mesial temporal origin, and is encountered less consistently with seizures of extratemporal neocortical origin. Although false localization is less likely with FDG-PET than with EEG, the hypometabolic zone merely reflects a focal functional deficit and its epileptogenicity must still be demonstrated electrophysiologically. When hemispherectomy or large multilobar resections are planned in small children, FDG-PET also provides useful supporting evidence that the contralateral hemisphere is functioning normally. It is difficult to obtain FDG-PET scans and to interpret results during spontaneous partial seizures. Ictal scans can be more easily obtained with single photon emission computed tomography (SPECT), which may provide information for planning surgical resections.

scholarly journals Multimodal Presurgical Evaluation of Refractory Localization-Related Epilepsy Involving Mesial Temporal Lobe Structures

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Rui Feng ◽  
Jie Hu ◽  
Chengxin Ma ◽  
Zhen Fan ◽  
Liqin Lang ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Fdg Pet ◽  
Structural Mri ◽  
Epileptogenic Zone ◽  
Source Imaging ◽  
Positron Emission ◽  
Ictal Eeg ◽  
Eeg Source Imaging ◽  
Mesial Temporal Lobe ◽  
Magnetic Resonance Imaging Mri

Abstract INTRODUCTION Localization-related epilepsy frequently involves mesial temporal lobe structures (MTLS), but sometimes presurgical workup can be confusing since shortage of definite structural lesional evidence or inconsistency among multimodal tools. Occasionally invasive workup is applied. This study evaluates the application of multimodal workup in surgical strategy making of localization-related epilepsy involving MTLS. METHODS Our study includes patients with significant or subtle MTLS abnormality (or magnetic resonance imaging (MRI) negative) in 3.0T MRI and then underwent resective surgeries encompassing MTLS. In addition to conventional workup tools, accurate EEG source imaging (ESI) technique based on individual head models is available. Patients accepted either 1-stage resective surgeries or staged surgeries (SEEG implantation + stage-2 resective surgeries). Contributions of structural MRI, fluorodeoxyglucose-positron emission tomography (FDG-PET), accurate ESI, and ictal EEG to surgical strategies were evaluated by criteria defining epileptogenic zone (resective scope in cases with good outcome). RESULTS Thirty-five patients who achieved Engel grade I + II outcome after resective surgeries were included. All together, 68.6% cases showed ESI sources totally falling into resective scope. 42.9% ictal EEG estimates, 57.1% PET focal hypometabolistic regions, 74.3% MRI structural lesions fitted the resective scope/side. In total, 75% 1-stage cases showed ESI sources being confined in MTLS region, while PET showed focal hypometabolism in 66.7% and MRI indicated single MTLS lesions (including subtle ones) in 79.2% cases. In total, 54.5% ESI sources and 63.6% MRI abnormality (single, including subtle ones) in staged cases showed complete concordance with SEEG findings. In subtle lesional/MRI negative cases, ESI generated sources confined within MTLS in 77.8% cases, while PET estimates are focally localizing in 44.4% cases and 55.6% showed subtle MRI lesions which were firstly diagnosed “negative.” CONCLUSION Multimodal noninvasive workup are contributable to help decide strategy of 1-stage resective surgeries and SEEG plans in localization-related epilepsy. High-quality structural MRI, accurate ESI technique based on scalp EEG as well as FDG-PET are key to presurgical planning of epilepsy involving MTLS.

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