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. 2022 Apr;122(2):325-335.
doi: 10.1007/s13760-020-01569-y. Epub 2021 Feb 5.

Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy

Maarten Haemels  1 , Donatienne Van Weehaeghe  2   3 , Evy Cleeren  4 , Patrick Dupont  5 , Johan van Loon  6   7 , Tom Theys  6   7 , Koen Van Laere  2   3 , Wim Van Paesschen  4   8 , Karolien Goffin  2   3
Affiliations

Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy

Maarten Haemels et al. Acta Neurol Belg. 2022 Apr.

Abstract

The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent 18F-FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, pFDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, pFDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.

Keywords: Epilepsy surgery; FDG PET; Perfusion SPECT; Postoperative outcome; Refractory focal epilepsy.

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References

    1. Bell GS, Sander JW (2001) The epidemiology of epilepsy: the size of the problem. Seizure 10(4):306–314. https://doi.org/10.1053/seiz.2001.0584 (quiz 315–306) - DOI - PubMed
    1. Cascino GD (2004) Surgical treatment for epilepsy. Epilepsy Res 60(2–3):179–186. https://doi.org/10.1016/j.eplepsyres.2004.07.003 - DOI - PubMed
    1. Kwan P, Brodie MJ (2000) Early identification of refractory epilepsy. N Engl J Med 342(5):314–319. https://doi.org/10.1056/NEJM200002033420503 - DOI - PubMed
    1. Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM (2017) Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58(4):522–530. https://doi.org/10.1111/epi.13670 - DOI - PubMed
    1. Vermeulen L, van Loon J, Theys T, Goffin J, Porke K, Van Laere K, Goffin K, Vandenbulcke M, Thijs V, Van Paesschen W (2016) Outcome after epilepsy surgery at the University Hospitals Leuven 1998–2012. Acta Neurol Belg 116(3):271–278. https://doi.org/10.1007/s13760-016-0605-6 - DOI - PubMed