Does F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy?

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dc.contributor.authorMenon, RN
dc.contributor.authorRadhakrishnan, A
dc.contributor.authorParameswaran, R
dc.contributor.authorThomas, B
dc.contributor.authorKesayadas, C
dc.contributor.authorAbraham, M
dc.contributor.authorVilanilam, G
dc.contributor.authorSarma, SP
dc.date.accessioned2017-03-10T03:26:19Z
dc.date.available2017-03-10T03:26:19Z
dc.date.issued2015
dc.description.abstractObjective: There is a dearth of information on the critical utility of positron emission tomography (PET) in choosing candidates for epilepsy surgery especially in resource-poor countries where it is not freely available. This study aimed to critically analyze the utility of FDG-PET in the presurgical evaluation and surgical selection of patients with DRE based on the results obtained through its use in our comprehensive epilepsy program. Methods: From 2008 to 2012, 117 patients with drug-resistant epilepsy underwent F-18 fluoro-deoxy-glucose (FDG) PET in our center. We utilized their data to audit the utility of PET in choosing/deferring patients for surgery. Results: Of the 117 patients (age: 5-42 years) who underwent F-18 FDG-PET, 64 had normal MRI, and 53 had lesions. Electroclinical data favored temporal ictal onset in 48 (41%), extratemporal in 60 (51.3%), and uncertain lobar localization in 9 (7.7%). The topography of PET hypometabolism was localizing in 53 (45.3%), lateralizing in 12 (10.3%), and 52 (44.4%) had either normal or discordant results. In the nonlesional group, focal hypometabolism was concordant to the area of ictal onset in 27 (41.5%) versus 38 (58.5%) in the lesional group (p = 0.002). Greater concordance was noted in temporal lobe epilepsy (TLE) (78.0%) as compared to extratemporal epilepsy (ETPE) (28.6%) (p < 0.001). Positron emission tomography was more concordant in patients with mesial temporal sclerosis than in those with other lesions (82.8% versus 50%) (p = 0.033). Positron emission tomography helped in surgical decision-making in 68.8% of TLE and 23.3% of ETPE cases. Overall, 37 patients (31.6%) were directly selected for resective surgery based on PET results. Conclusions: Positron emission tomography, when utilized judiciously, remained an ancillary tool in the surgical selection of one-third of patients with drug-resistant partial epilepsy, although its utility as an independent tool is not very promising. (C) 2015 Elsevier Inc. All rights reserved.
dc.identifier.citation51 ,;133-139en_US
dc.identifier.uri10.1016/j.yebeh.2015.07.004
dc.identifier.urihttps://dspace.sctimst.ac.in/handle/123456789/9606
dc.publisherEPILEPSY & BEHAVIOR
dc.subjectBehavioral Sciences; Neurosciences & Neurology; Psychiatry
dc.titleDoes F-18 FDG-PET substantially alter the surgical decision-making in drug-resistant partial epilepsy?
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