Surgical decision making in temporal lobe epilepsy: a comparison of [(18)F]FDG-PET, MRI, and EEG

Epilepsy Behav. 2011 Oct;22(2):293-7. doi: 10.1016/j.yebeh.2011.06.022. Epub 2011 Jul 27.

Abstract

Objectives: The goals of this work were (1) to determine the effect of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), MRI, and EEG on the decision to perform temporal lobe epilepsy (TLE) surgery, and (2) to determine if FDG-PET, MRI, or EEG predicts surgical outcome.

Methods: All PET scans ordered (2000-2010) for epilepsy or seizures were tabulated. Medical records were investigated to determine eligibility and collect data. Statistical analysis included odds ratios, κ statistics, univariate analysis, and logistic regression.

Results: Of the 186 patients who underwent FDG-PET, 124 had TLE, 50 were surgical candidates, and 34 had surgery with post-operative follow-up. Median length of follow-up was 24 months. MRI, FDG-PET, and EEG were significant predictors of surgical candidacy (P<0.001) with odds ratios of 42.8, 20.4, and 6.3, respectively. FDG-PET was the only significant predictor of postoperative outcome (P<0.01).

Conclusion: MRI showed a trend toward having the most influence on surgical candidacy, but only FDG-PET predicted surgical outcome.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Decision Making*
  • Electroencephalography / methods*
  • Epilepsy, Temporal Lobe / diagnosis*
  • Epilepsy, Temporal Lobe / physiopathology
  • Epilepsy, Temporal Lobe / surgery
  • Fluorodeoxyglucose F18*
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods
  • Predictive Value of Tests
  • Tomography, Emission-Computed / methods*
  • Treatment Outcome

Substances

  • Fluorodeoxyglucose F18