{18F}fluorodeoxyglucose positron emission tomography in refractory complex partial seizures

Authors

  • Dr. William H. Theodore MD,

    Corresponding author
    1. Epilepsy Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
    2. Clinical Epilepsy Section, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
    • Epilepsy Branch, NINCDS, Federal Bldg, Rm 114, Bethesda, MD 20205
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  • Michael E. Newmark MD,

    1. Epilepsy Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
    2. Clinical Epilepsy Section, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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  • Susumu Sato MD,

    1. Epilepsy Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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  • Rodney Brooks PhD,

    1. Surgical Neurology Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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  • Nicholas Patronas MD,

    1. Surgical Neurology Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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  • Robert de la Paz MD,

    1. Surgical Neurology Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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  • Giovanni Dichiro MD,

    1. Surgical Neurology Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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  • Robert M. Kessler MD,

    1. Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20205
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  • Richard Margolin MD,

    1. Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20205
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  • Ronald G. Manning PhD,

    1. Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20205
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  • Michael Channing PhD,

    1. Nuclear Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20205
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  • Roger J. Porter MD

    1. Epilepsy Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
    2. Clinical Epilepsy Section, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, MD 20205
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Abstract

Positron emission tomography with simultaneous electroencephalographic monitoring was performed with {18F}fluorodeoxyglucose in 20 patients with complex partial seizures who had normal computed tomographic scans. Seven patients had only unilateral epileptiform discharges on the electroencephalogram, 3 had predominantly unilateral discharges, and 10 had nonlocalized epileptiform abnormalities. Positron emission tomography showed a hypometabolic lesion in 16 of the 20 patients. Pathological changes in the hypometabolic region were found in postoperative specimens in 4 of 5 patients studied. Positron emission tomography was unaffected by the seizure frequency, state of alertness, or number of spike discharges during the scan. There was a tendency for patients to have higher overall metabolic rates when taking less medication. Seizures occurring during {18F}fluorodeoxyglucose uptake in 3 patients produced a hypermetabolic area at the interictal hypometabolic focus. Positron emission tomography sometimes showed more widespread hypometabolism than suspected on the basis of the scalp-recorded electroencephalogram. The frontal lobe showed a greater degree of hypometabolism than the temporal lobe in 3 patients. Focal lesions may be identified by positron emission tomography even if the electroencephalographic abnormality is not well localized.

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