Positron emission tomography in patients with drug-resistant epilepsy
- Minkin ,I. Kostadinova ,D. Zlatareva, P. Dimova,I. Litvinenko,
- Penkov, Y. Todorov,S. Nachev, M. Marinov
Abstract. Positron emission tomography with 18Fluordeoxyglucose (18FDG PET) was introduced as method of evaluation of the cerebral metabolism in the early 80s.18FDG PET/computed tomography (PET/CT) has rapidly become a method of epileptogenic zone localization because of the hypometabolism of this zone during the interictal period. This paper represents the first Bulgarian series of patients with drug- resistant epilepsy who were evaluated with 18FDG PET as part of the presurgical work-up. Our study has included 21 patients with drug-resistant epilepsy who were evaluated with 18FDG PET/CT from January 2010 to May 2013. All patients were evaluated with dedicated MRI epilepsy protocol. PET/CT study was fused with 3D MRI study using FSL or GE software. Video EEG monitoring was performed in all 21 patients and seizures were recorded in 18 patients. Hypometabolic zones were found in 15 patients. The hypometabolism was focal in 5 patients, multilobar in 9 patients and hemispheric in 1 patient. The MRI was normal in 8 patients. Hypometabolic zones were found in 3 of these 8 patients with cryptogenic epilepsy. Epilepsy surgery was performed in 6 cases. All operated patients were with hypometabolic zones. Significant seizure reduction after surgery was observed in 5 of 6 operated patients. 18FDG PET/CT is a valuable method for epileptogenic zone localization in patients with drug-resistant epilepsy. The introduction of this method in the bulgarian epilepsy surgery program increases the chances for successful resective surgery.
Key words: 18FDG PET /CT. DRUG-RESISTANT EPILEPSY. DIAGNOSIS OF EPILEPSY