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Dai Y, Zhu Z, Tang Y, Xiao L, Liu X, Zhang M, Xiao B, Hu K, Long L, Xie Y, Hu S. The clinical and predictive value of 18F-FDG PET/CT metabolic patterns in a clinical Chinese cohort with autoimmune encephalitis. CNS Neurosci Ther 2024; 30:e14821. [PMID: 38948940 PMCID: PMC11215490 DOI: 10.1111/cns.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/29/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024] Open
Abstract
AIMS To investigate the diagnostic and predictive role of 18F-FDG PET/CT in patients with autoimmune encephalitis (AE) as a whole group. METHODS Thrty-five patients (20 females and 15 males) with AE were recruited. A voxel-to-voxel semi-quantitative analysis based on SPM12 was used to analyze 18F-FDG PET/CT imaging data compared to healthy controls. Further comparison was made in different prognostic groups categorized by modified Rankin Scale (mRS). RESULTS In total, 24 patients (68.6%) were tested positive neuronal antibodies in serum and/or CSF. Psychiatric symptoms and seizure attacks were major clinical symptoms. In the acute stage, 13 patients (37.1%) demonstrated abnormal brain MRI results, while 33 (94.3%) presented abnormal metabolism patterns. 18F-FDG PET/CT was more sensitive than MRI (p < 0.05). Patients with AE mainly presented mixed metabolism patterns compared to the matched controls, demonstrating hypermetabolism mainly in the cerebellum, BG, MTL, brainstem, insula, middle frontal gyrus, and relatively hypometabolism in the frontal cortex, occipital cortex, temporal gyrus, right parietal gyrus, left cingulate gyrus (p < 0.05, FWE corrected). After a median follow-up of 26 months, the multivariable analysis identified a decreased level of consciousness as an independent risk factor associated with poor outcome of AE (HR = 3.591, p = 0.016). Meanwhile, decreased metabolism of right superior frontal gyrus along with increased metabolism of the middle and upper brainstem was more evident in patients with poor outcome (p < 0.001, uncorrected). CONCLUSION 18F-FDG PET/CT was more sensitive than MRI to detect neuroimaging abnormalities of AE. A mixed metabolic pattern, characterized by large areas of cortical hypometabolism with focal hypermetabolism was a general metabolic pattern. Decreased metabolism of right superior frontal gyrus with increased metabolism of the middle and upper brainstem may predict poor long-term prognosis of AE.
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Affiliation(s)
- Yuwei Dai
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Zehua Zhu
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Department of Nuclear Medicine, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Division of Life Sciences and Medicine, Department of Nuclear Medicine, The First Affiliated Hospital of USTCUniversity of Science and Technology of ChinaHefeiAnhuiP.R. China
| | - Yongxiang Tang
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Department of Nuclear Medicine, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
| | - Ling Xiao
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Department of Nuclear Medicine, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
| | - Xianghe Liu
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Min Zhang
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Bo Xiao
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Kai Hu
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Lili Long
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Yuanyuan Xie
- Department of Neurology, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Clinical Research Center for Epileptic disease of Hunan ProvinceCentral South UniversityChangshaHunanP.R. China
| | - Shuo Hu
- National Clinical Research Center for Geriatric Diseases, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Department of Nuclear Medicine, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
- Key Laboratory of Biological Nanotechnology of National Health Commission, Xiangya HospitalCentral South UniversityChangshaHunanP.R. China
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Govil-Dalela T, Kumar A, Behen M, Chugani HT, Juhász C. Evolution of lobar abnormalities of cerebral glucose metabolism in 41 children with drug-resistant epilepsy. Epilepsia 2018; 59:1307-1315. [PMID: 29786852 PMCID: PMC6031462 DOI: 10.1111/epi.14404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We analyzed long-term changes of lobar glucose metabolic abnormalities in relation to clinical seizure variables and development in a large group of children with medically refractory epilepsy. METHODS Forty-one children (25 males) with drug-resistant epilepsy had a baseline positron emission tomography (PET) scan at a median age of 4.7 years; the scans were repeated after a median of 4.3 years. Children with progressive neurological disorders or space-occupying lesion-related epilepsy and those who had undergone epilepsy surgery were excluded. The number of affected lobes on 2-deoxy-2(18 F)-fluoro-D-glucose-PET at baseline and follow-up was correlated with epilepsy variables and developmental outcome. RESULTS On the initial PET scan, 24 children had unilateral and 13 had bilateral glucose hypometabolism, whereas 4 children had normal scans. On the follow-up scan, 63% of the children showed an interval expansion of the hypometabolic region, and this progression was associated with persistent seizures. In contrast, 27% showed less extensive glucose hypometabolism at follow-up; most of these subjects manifested a major interval decrease in seizure frequency. Delayed development was observed in 21 children (51%) at baseline and 28 (68%) at follow-up. The extent of glucose hypometabolism at baseline correlated with developmental levels at the time of both baseline (r = .31, P = .05) and follow-up scans (r = .27, P = .09). SIGNIFICANCE In this PET study of unoperated children with focal epilepsy, the lobar pattern of glucose hypometabolism changed over time in 90% of the cases. The results support the notion of an expansion of metabolic dysfunction in children with persistent frequent seizures and its association with developmental delay, and support that optimized medical treatment to control seizures may contribute to better neurocognitive outcome if no surgery can be offered.
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Affiliation(s)
- Tuhina Govil-Dalela
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ajay Kumar
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
- PET Center and Translational Imaging Laboratory, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Michael Behen
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
- PET Center and Translational Imaging Laboratory, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Harry T. Chugani
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- PET Center and Translational Imaging Laboratory, Children’s Hospital of Michigan, Detroit, MI, USA
- Division of Pediatric Neurology, Nemours A.I. DuPont Hospital for Children, Wilmington, DE, USA
- Departments of Neurology and Pediatrics, Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, USA
| | - Csaba Juhász
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
- PET Center and Translational Imaging Laboratory, Children’s Hospital of Michigan, Detroit, MI, USA
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
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Probasco JC, Solnes L, Nalluri A, Cohen J, Jones KM, Zan E, Javadi MS, Venkatesan A. Decreased occipital lobe metabolism by FDG-PET/CT: An anti-NMDA receptor encephalitis biomarker. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 5:e413. [PMID: 29159205 PMCID: PMC5688263 DOI: 10.1212/nxi.0000000000000413] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/28/2017] [Indexed: 01/17/2023]
Abstract
Objective: To compare brain metabolism patterns on fluorodeoxyglucose (FDG)-PET/CT in anti–NMDA receptor and other definite autoimmune encephalitis (AE) and to assess how these patterns differ between anti–NMDA receptor neurologic disability groups. Methods: Retrospective review of clinical data and initial dedicated brain FDG-PET/CT studies for neurology inpatients with definite AE, per published consensus criteria, treated at a single academic medical center over a 10-year period. Z-score maps of FDG-PET/CT were made using 3-dimensional stereotactic surface projections in comparison to age group–matched controls. Brain region mean Z scores with magnitudes ≥2.00 were interpreted as significant. Comparisons were made between anti–NMDA receptor and other definite AE patients as well as among patients with anti–NMDA receptor based on modified Rankin Scale (mRS) scores at the time of FDG-PET/CT. Results: The medial occipital lobes were markedly hypometabolic in 6 of 8 patients with anti–NMDA receptor encephalitis and as a group (Z = −4.02, interquartile range [IQR] 2.14) relative to those with definite AE (Z = −2.32, 1.46; p = 0.004). Among patients with anti–NMDA receptor encephalitis, the lateral and medial occipital lobes were markedly hypometabolic for patients with mRS 4–5 (lateral occipital lobe Z = −3.69, IQR 1; medial occipital lobe Z = −4.08, 1) compared with those with mRS 0–3 (lateral occipital lobe Z = −0.83, 2; p < 0.0005; medial occipital lobe Z = −1.07, 2; p = 0.001). Conclusions: Marked medial occipital lobe hypometabolism by dedicated brain FDG-PET/CT may serve as an early biomarker for discriminating anti–NMDA receptor encephalitis from other AE. Resolution of lateral and medial occipital hypometabolism may correlate with improved neurologic status in anti–NMDA receptor encephalitis.
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Affiliation(s)
- John C Probasco
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lilja Solnes
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abhinav Nalluri
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jesse Cohen
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Krystyna M Jones
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elcin Zan
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mehrbod S Javadi
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arun Venkatesan
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center; Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation; and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
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Probasco JC, Solnes L, Nalluri A, Cohen J, Jones KM, Zan E, Javadi MS, Venkatesan A. Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e352. [PMID: 28567435 PMCID: PMC5442608 DOI: 10.1212/nxi.0000000000000352] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/27/2017] [Indexed: 12/14/2022]
Abstract
Objective: To compare the rate of abnormal brain metabolism by FDG-PET/CT to other paraclinical findings and to describe brain metabolism patterns in autoimmune encephalitis (AE). Methods: A retrospective review of clinical data and initial dedicated brain FDG-PET/CT studies for neurology inpatients with AE, per consensus criteria, treated at a single tertiary center over 123 months. Z-score maps of FDG-PET/CT were made using 3-dimensional stereotactic surface projections with comparison to age group–matched controls. Brain region mean Z-scores with magnitudes ≥2.00 were interpreted as significant. Comparisons were made to rates of abnormal initial brain MRI, abnormal initial EEG, and presence of intrathecal inflammation. Results: Sixty-one patients with AE (32 seropositive) underwent brain FDG-PET/CT at median 4 weeks of symptoms (interquartile range [IQR] 9 weeks) and median 4 days from MRI (IQR 8.5 days). FDG-PET/CT was abnormal in 52 (85%) patients, with 42 (69%) demonstrating only hypometabolism. Isolated hypermetabolism was demonstrated in 2 (3%) patients. Both hypermetabolic and hypometabolic brain regions were noted in 8 (13%) patients. Nine (15%) patients had normal FDG-PET/CT studies. CSF inflammation was evident in 34/55 (62%) patients, whereas initial EEG (17/56, 30%) and MRI (23/57, 40%) were abnormal in fewer. Detection of 2 or more of these paraclinical findings was in weak agreement with abnormal brain FDG-PET/CT (κ = 0.16, p = 0.02). Conclusions: FDG-PET/CT was more often abnormal than initial EEG, MRI, and CSF studies in neurology inpatients with AE, with brain region hypometabolism the most frequently observed.
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Affiliation(s)
- John C Probasco
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lilja Solnes
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Abhinav Nalluri
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jesse Cohen
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Krystyna M Jones
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elcin Zan
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mehrbod S Javadi
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arun Venkatesan
- Department of Neurology (J.C.P., A.N., J.C., A.V.), Johns Hopkins Encephalitis Center, Department of Neurology (J.C.P.), Johns Hopkins Center for Refractory Status Epilepticus and Neuroinflammation, and Russell H. Morgan Department of Radiology and Radiological Sciences (L.S., K.M.J., E.Z., M.S.J.), Johns Hopkins University School of Medicine, Baltimore, MD
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Zhu Y, Feng J, Wu S, Hou H, Ji J, Zhang K, Chen Q, Chen L, Cheng H, Gao L, Chen Z, Zhang H, Tian M. Glucose Metabolic Profile by Visual Assessment Combined with Statistical Parametric Mapping Analysis in Pediatric Patients with Epilepsy. J Nucl Med 2017; 58:1293-1299. [PMID: 28104740 DOI: 10.2967/jnumed.116.187492] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
PET with 18F-FDG has been used for presurgical localization of epileptogenic foci; however, in nonsurgical patients, the correlation between cerebral glucose metabolism and clinical severity has not been fully understood. The aim of this study was to evaluate the glucose metabolic profile using 18F-FDG PET/CT imaging in patients with epilepsy. Methods: One hundred pediatric epilepsy patients who underwent 18F-FDG PET/CT, MRI, and electroencephalography examinations were included. Fifteen age-matched controls were also included. 18F-FDG PET images were analyzed by visual assessment combined with statistical parametric mapping (SPM) analysis. The absolute asymmetry index (|AI|) was calculated in patients with regional abnormal glucose metabolism. Results: Visual assessment combined with SPM analysis of 18F-FDG PET images detected more patients with abnormal glucose metabolism than visual assessment only. The |AI| significantly positively correlated with seizure frequency (P < 0.01) but negatively correlated with the time since last seizure (P < 0.01) in patients with abnormal glucose metabolism. The only significant contributing variable to the |AI| was the time since last seizure, in patients both with hypometabolism (P = 0.001) and with hypermetabolism (P = 0.005). For patients with either hypometabolism (P < 0.01) or hypermetabolism (P = 0.209), higher |AI| values were found in those with drug resistance than with seizure remission. In the post-1-y follow-up PET studies, a significant change of |AI| (%) was found in patients with clinical improvement compared with those with persistence or progression (P < 0.01). Conclusion:18F-FDG PET imaging with visual assessment combined with SPM analysis could provide cerebral glucose metabolic profiles in nonsurgical epilepsy patients. |AI| might be used for evaluation of clinical severity and progress in these patients. Patients with a prolonged period of seizure freedom may have more subtle (or no) metabolic abnormalities on PET. The clinical value of PET might be enhanced by timing the scan closer to clinical seizures.
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Affiliation(s)
- Yuankai Zhu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianhua Feng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Shuang Wu
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haifeng Hou
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Jianfeng Ji
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Qing Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Lin Chen
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Haiying Cheng
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Liuyan Gao
- Department of Pediatrics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China; and
| | - Zexin Chen
- Department of Clinical Epidemiology & Biostatistics, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China.,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Mei Tian
- Department of Nuclear Medicine, The Second Hospital of Zhejiang University School of Medicine, Hangzhou, China .,Zhejiang University Medical PET Center, Hangzhou, China.,Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.,Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
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Abstract
Positron emission tomography (PET) has been widely used in the study of seizure disorders. As a research tool, PET has been used to determine the pathophysiology of different seizures disorders, prognostic and diagnostic information, and the response to various interventions. PET imaging has also been used clinically to help with the detection of seizure foci. With the continued development of a large array of radiopharmaceuticals that can evaluate all of the components of different neurotransmitter systems as well as cerebral blood flow and metabolism, PET imaging will continue to play a key role in research and clinical applications for seizure disorders.
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Affiliation(s)
- Abass Alavi
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zhang HL, Wu J. Cortical metabolism detected by PET in NMDA receptor encephalitis. Pediatr Neurol 2011; 44:78; author reply 78-9. [PMID: 21147396 DOI: 10.1016/j.pediatrneurol.2010.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2010] [Indexed: 11/27/2022]
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Abstract
Positron emission tomography (PET) imaging has been widely used in the evaluation and management of patients with seizure disorders. The ability of PET to measure cerebral function makes it ideal for studying the neurophysiologic correlates of seizure activity during ictal and interictal states. PET imaging is also useful for evaluating patients before surgical interventions to determine the best surgical method and maximize outcomes. Thus, PET will continue to play a major role not only in the clinical arena but in further investigations of the pathogenesis and management of various seizure disorders. This article reviews the literature regarding the current uses and indications for PET in the study and management of patients with seizure disorders.
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Affiliation(s)
- Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Andrew B Newberg
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
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De Bundel D, Smolders I, Vanderheyden P, Michotte Y. Ang II and Ang IV: unraveling the mechanism of action on synaptic plasticity, memory, and epilepsy. CNS Neurosci Ther 2009; 14:315-39. [PMID: 19040556 DOI: 10.1111/j.1755-5949.2008.00057.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The central angiotensin system plays a crucial role in cardiovascular regulation. More recently, angiotensin peptides have been implicated in stress, anxiety, depression, cognition, and epilepsy. Angiotensin II (Ang II) exerts its actions through AT(1) and AT(2) receptors, while most actions of its metabolite Ang IV were believed to be independent of AT(1) or AT(2) receptor activation. A specific binding site with high affinity for Ang IV was discovered and denominated "AT(4) receptor". The beneficiary effects of AT(4) ligands in animal models for cognitive impairment and epileptic seizures initiated the search for their mechanism of action. This proved to be a challenging task, and after 20 years of research, the nature of the "AT(4) receptor" remains controversial. Insulin-regulated aminopeptidase (IRAP) was first identified as the high-affinity binding site for AT(4) ligands. Recently, the hepatocyte growth factor receptor c-MET was also proposed as a receptor for AT(4) ligands. The present review focuses on the effects of Ang II and Ang IV on synaptic transmission and plasticity, learning, memory, and epileptic seizure activity. Possible interactions of Ang IV with the classical AT(1) and AT(2) receptor subtypes are evaluated, and other potential mechanisms by which AT(4) ligands may exert their effects are discussed. Identification of these mechanisms may provide a valuable target in the development in novel drugs for the treatment of cognitive disorders and epilepsy.
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Affiliation(s)
- Dimitri De Bundel
- Research Group Experimental Pharmacology, Department of Pharmaceutical Chemistry, Drug Analysis and Drug Information, Vrije Universiteit Brussel, Brussels, Belgium
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A comparative study of bioradiography in human brain slices and preoperative PET imaging. Brain Res 2007; 1142:19-27. [DOI: 10.1016/j.brainres.2007.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 01/09/2007] [Accepted: 01/09/2007] [Indexed: 11/19/2022]
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Benedek K, Juhász C, Chugani DC, Muzik O, Chugani HT. Longitudinal changes in cortical glucose hypometabolism in children with intractable epilepsy. J Child Neurol 2006; 21:26-31. [PMID: 16551449 DOI: 10.1177/08830738060210011101] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In children with partial epilepsy, there is increasing evidence to suggest that not all cortical regions showing glucose hypometabolism on positron emission tomography (PET) represent epileptogenic cortex but that some hypometabolic areas might be the result of repeated seizures. Most of the supportive data, however, have come from cross-sectional imaging studies. To evaluate longitudinal changes in cortical glucose hypometabolism, we compared two sequential [(18)F]fluorodeoxyglucose (FDG) PET scans performed 7 to 44 months apart in 15 children with intractable nonlesional partial epilepsy. The extent of hypometabolic cortex on the side of the electroencephalography-verified epileptic focus and its changes between the two PET scans were measured and correlated to clinical seizure variables. The change in seizure frequency between the two PET scans correlated positively with the change in the extent of cortical glucose hypometabolism (r = .8, P <.001). Most patients with persistent or increased seizure frequency (one or more seizures per day) showed enlargement in the area of hypometabolic cortex on the second PET scan. In contrast, patients whose seizure frequency had decreased below daily seizures between the first and second PET scans showed a decrease in the size of the hypometabolic cortex. These results support the notion that the extent of cortical glucose hypometabolism on PET scanning can undergo dynamic changes, and these are, at least partly, related to the frequency of seizures. The findings have implications on how aggressively persistent seizures should be treated in children. (J Child Neurol 2006;21:26-31).
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Affiliation(s)
- Krisztina Benedek
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Abstract
PET imaging has been widely used in the evaluation and management of patients with seizure disorders. The ability of PET to measure cerebral function is ideal for studying the neurophysiologic correlates of seizure activity during both ictal and interictal states. PET imaging is also valuable for evaluating patients before surgical interventions to determine the best surgical method and maximize outcomes. PET will continue to play a major role, not only in the clinical arena, but also in investigating the pathogenesis and treatment of various seizure disorders.
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Affiliation(s)
- Andrew B Newberg
- Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 110 Donner Building, Philadelphia, PA 19104, USA.
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Benedek K, Juhász C, Muzik O, Chugani DC, Chugani HT. Metabolic Changes of Subcortical Structures in Intractable Focal Epilepsy. Epilepsia 2004; 45:1100-5. [PMID: 15329075 DOI: 10.1111/j.0013-9580.2004.43303.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Intractable focal epilepsy is commonly associated with cortical glucose hypometabolism on interictal 2-deoxy-2[18F]-fluoro-D-glucose (FDG) positron emission tomography (PET). However, subcortical brain structures also may show hypometabolism on PET and volume changes on magnetic resonance imaging (MRI) studies, and these are less well understood in terms of their pathophysiology and clinical significance. In the present study, we analyzed alterations of glucose metabolism in subcortical nuclei and hippocampus by using FDG-PET in young patients with intractable epilepsy. METHODS Thirty-seven patients (mean age, 7.5 years; age range, 1-27 years) with intractable frontal (n = 23) and temporal (n = 14) lobe epilepsy underwent FDG-PET scanning as part of their presurgical evaluation. Normalized glucose metabolism was measured in the thalamus and caudate and lentiform nuclei, as well as in hippocampus, both ipsi- and contralateral to the epileptic focus, and correlated with duration and age at onset of epilepsy, presence or absence of secondary generalization, location of the epileptic focus, and extent of cortical glucose hypometabolism. RESULTS Long duration of epilepsy was associated with lower glucose metabolism in the ipsilateral thalamus and hippocampus. Duration of epilepsy was a significant predictor of ipsilateral thalamic glucose metabolism in both temporal and frontal lobe epilepsy. Presence of secondarily generalized seizures also was associated with lower normalized metabolism in the ipsilateral thalamus and hippocampus. Extent of cortical hypometabolism did not correlate with subcortical metabolism, and glucose metabolism in the caudate and lentiform nuclei did not show any correlation with the clinical variables. CONCLUSIONS The findings suggest that metabolic dysfunction of the thalamus ipsilateral to the seizure focus may become more severe with long-standing temporal and frontal lobe epilepsy, and also with secondary generalization of seizures.
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Affiliation(s)
- Krisztina Benedek
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Chiron C. L’imagerie fonctionnelle chez l’enfant. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71191-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION It has been proposed that the greater efficacy of bilateral (BL) over right unilateral (RUL) electroconvulsive therapy (ECT) at low stimulus intensity is due to differences in site of seizure initiation. We hypothesized that focal prefrontal seizures are more common with BL than RUL administration. METHOD Records were reviewed of the 1,007 ECT treatments of 84 consecutive patients randomized to RUL or BL electrode placement. RESULTS Eight events were identified in which there was an electroencephalographic seizure without motor manifestation. All of these events occurred at titration sessions and with BL stimuli (p = 0.002). These events were more likely to occur later in the course of treatment. DISCUSSION We suggest that BL ECT may induce focal seizures in prefrontal areas and that these seizures are more likely to occur later in the treatment course.
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Affiliation(s)
- L S Boylan
- Department of Neurology, New York University School of Medicine, New York, New York, USA
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