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. 2021 Sep;31(5):869-873.
doi: 10.1111/jon.12874. Epub 2021 May 6.

Brain FDG-PET findings in glutamic acid decarboxylase antibody-associated epilepsy

Neus Mongay-Ochoa  1 , Jacint Sala-Padró  1 , Gabriel Reynés-Llompart  2   3 , Laura Rodríguez-Bel  3 , Sònia Jaraba  1 , Francisco Morandeira  4 , Mercè Falip  1
Affiliations

Brain FDG-PET findings in glutamic acid decarboxylase antibody-associated epilepsy

Neus Mongay-Ochoa et al. J Neuroimaging. 2021 Sep.

Abstract

Background and purpose: Glutamic acid decarboxylase antibodies (GAD-Ab) are sometimes associated with chronic drug-resistant focal epilepsy. Clinically, it may manifest as mesial temporal lobe epilepsy (mTLE), with GAD-Ab patients difficult to distinguish. Therefore, the aim of this study is to compare brain metabolism of patients with mTLE and high serum titers of GAD-Ab (>2000 UI/ml) to those with mTLE and hippocampal sclerosis (HS) and confirmed GAD-ab negativity.

Methods: Images from PET studies were normalized to an SPM 12 template. Voxel to voxel comparisons were made using a two-sample one-tailed t-test.

Results: In both patients with GAD-Ab and controls (mTLE-HS), hypometabolism in mesial temporal lobe areas was observed. When comparing the two groups, GAD-Ab patients had statistically significant reduced metabolism in both insulae and medial inferior frontal-hypothalamus area (p < 0.001).

Conclusions: Hypometabolism in mesial temporal lobe areas together with hypometabolism in insulae and medial inferior frontal-hypothalamus may be characteristic of patients with epilepsy and GAD-ab. This PET pattern could be a useful diagnostic tool to identify GAD-Ab patients.

Keywords: FDG-PET; GAD antibodies; hippocampal sclerosis; insulae; medial temporal lobe epilepsy.

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References

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