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05.02.2021 | Original article

Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy

verfasst von: Maarten Haemels, Donatienne Van Weehaeghe, Evy Cleeren, Patrick Dupont, Johan van Loon, Tom Theys, Koen Van Laere, Wim Van Paesschen, Karolien Goffin

Erschienen in: Acta Neurologica Belgica | Ausgabe 2/2022

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Abstract

The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent ¹⁸F‐FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, p_FDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, p_FDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.

Bell GS, Sander JW (2001) The epidemiology of epilepsy: the size of the problem. Seizure 10(4):306–314. https://doi.org/10.1053/seiz.2001.0584 (quiz 315–306)CrossRefPubMed

Cascino GD (2004) Surgical treatment for epilepsy. Epilepsy Res 60(2–3):179–186. https://doi.org/10.1016/j.eplepsyres.2004.07.003CrossRefPubMed

Kwan P, Brodie MJ (2000) Early identification of refractory epilepsy. N Engl J Med 342(5):314–319. https://doi.org/10.1056/NEJM200002033420503CrossRefPubMed

Fisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, Lagae L, Moshé SL, Peltola J, Roulet Perez E, Scheffer IE, Zuberi SM (2017) Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58(4):522–530. https://doi.org/10.1111/epi.13670CrossRefPubMed

Vermeulen L, van Loon J, Theys T, Goffin J, Porke K, Van Laere K, Goffin K, Vandenbulcke M, Thijs V, Van Paesschen W (2016) Outcome after epilepsy surgery at the University Hospitals Leuven 1998–2012. Acta Neurol Belg 116(3):271–278. https://doi.org/10.1007/s13760-016-0605-6CrossRefPubMed

Cahill V, Sinclair B, Malpas CB, McIntosh AM, Chen Z, Vivash LE, O’Shea MF, Wilson SJ, Desmond PM, Berlangieri SU, Hicks RJ, Rowe CC, Morokoff AP, King JA, Fabinyi GC, Kaye AH, Kwan P, Berkovic SF, O’Brien TJ (2019) Metabolic patterns and seizure outcomes following anterior temporal lobectomy. Ann Neurol 85(2):241–250. https://doi.org/10.1002/ana.25405CrossRefPubMed

Boerwinkle VL, Cediel EG, Mirea L, Williams K, Kerrigan JF, Lam S, Raskin JS, Desai VR, Wilfong AA, Adelson PD, Curry DJ (2019) Network-targeted approach and postoperative resting-state functional magnetic resonance imaging are associated with seizure outcome. Ann Neurol 86(3):344–356. https://doi.org/10.1002/ana.25547CrossRefPubMed

Kini LG, Bernabei JM, Mikhail F, Hadar P, Shah P, Khambhati AN, Oechsel K, Archer R, Boccanfuso J, Conrad E, Shinohara RT, Stein JM, Das S, Kheder A, Lucas TH, Davis KA, Bassett DS, Litt B (2019) Virtual resection predicts surgical outcome for drug-resistant epilepsy. Brain 142(12):3892–3905. https://doi.org/10.1093/brain/awz303CrossRefPubMedPubMedCentral

Laiou P, Avramidis E, Lopes MA, Abela E, Müller M, Akman OE, Richardson MP, Rummel C, Schindler K, Goodfellow M (2019) Quantification and selection of ictogenic zones in epilepsy surgery. Front Neurol 10:1045. https://doi.org/10.3389/fneur.2019.01045CrossRefPubMedPubMedCentral

10.

Carboni M, Rubega M, Iannotti GR, De Stefano P, Toscano G, Tourbier S, Pittau F, Hagmann P, Momjian S, Schaller K, Seeck M, Michel CM, van Mierlo P, Vulliemoz S (2019) The network integration of epileptic activity in relation to surgical outcome. Clin Neurophysiol 130(12):2193–2202. https://doi.org/10.1016/j.clinph.2019.09.006CrossRefPubMed

11.

Frauscher B (2020) Localizing the epileptogenic zone. Curr Opin Neurol 33(2):198–206. https://doi.org/10.1097/WCO.0000000000000790CrossRefPubMed

12.

Cendes F, Theodore WH, Brinkmann BH, Sulc V, Cascino GD (2016) Neuroimaging of epilepsy. Handb Clin Neurol 136:985–1014. https://doi.org/10.1016/B978-0-444-53486-6.00051-XCrossRefPubMedPubMedCentral

13.

Lascano AM, Perneger T, Vulliemoz S, Spinelli L, Garibotto V, Korff CM, Vargas MI, Michel CM, Seeck M (2016) Yield of MRI, high-density electric source imaging (HD-ESI), SPECT and PET in epilepsy surgery candidates. Clin Neurophysiol 127(1):150–155. https://doi.org/10.1016/j.clinph.2015.03.025CrossRefPubMed

14.

Tomás J, Pittau F, Hammers A, Bouvard S, Picard F, Vargas MI, Sales F, Seeck M, Garibotto V (2019) The predictive value of hypometabolism in focal epilepsy: a prospective study in surgical candidates. Eur J Nucl Med Mol Imaging 46(9):1806–1816. https://doi.org/10.1007/s00259-019-04356-xCrossRefPubMed

15.

Guedj E, Bonini F, Gavaret M, Trébuchon A, Aubert S, Boucekine M, Boyer L, Carron R, McGonigal A, Bartolomei F (2015) 18FDG-PET in different subtypes of temporal lobe epilepsy: SEEG validation and predictive value. Epilepsia 56(3):414–421. https://doi.org/10.1111/epi.12917CrossRefPubMed

16.

Kogias E, Klingler JH, Urbach H, Scheiwe C, Schmeiser B, Doostkam S, Zentner J, Altenmüller DM (2017) 3 Tesla MRI-negative focal epilepsies: presurgical evaluation, postoperative outcome and predictive factors. Clin Neurol Neurosurg 163:116–120. https://doi.org/10.1016/j.clineuro.2017.10.038CrossRefPubMed

17.

Struck AF, Hall LT, Floberg JM, Perlman SB, Dulli DA (2011) Surgical decision making in temporal lobe epilepsy: a comparison of [(18)F]FDG-PET, MRI, and EEG. Epilepsy Behav 22(2):293–297. https://doi.org/10.1016/j.yebeh.2011.06.022CrossRefPubMedPubMedCentral

18.

Kim DW, Lee SK, Moon HJ, Jung KY, Chu K, Chung CK (2017) Surgical treatment of nonlesional neocortical epilepsy: long-term longitudinal study. JAMA Neurol 74(3):324–331. https://doi.org/10.1001/jamaneurol.2016.4439CrossRefPubMed

19.

Lee SK, Lee SY, Kim KK, Hong KS, Lee DS, Chung CK (2005) Surgical outcome and prognostic factors of cryptogenic neocortical epilepsy. Ann Neurol 58(4):525–532. https://doi.org/10.1002/ana.20569CrossRefPubMed

20.

Knowlton RC, Laxer KD, Ende G, Hawkins RA, Wong ST, Matson GB, Rowley HA, Fein G, Weiner MW (1997) Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy. Ann Neurol 42(6):829–837. https://doi.org/10.1002/ana.410420603CrossRefPubMedPubMedCentral

21.

Uijl SG, Leijten FSS, Arends JBAM, Parra J, Van Huffelen AC, Moons KGM (2008) Prognosis after temporal lobe epilepsy surgery: the value of combining predictors. Epilepsia 49(8):1317–1323. https://doi.org/10.1111/j.1528-1167.2008.01695.xCrossRefPubMed

22.

Choi JY, Kim SJ, Hong SB, Seo DW, Hong SC, Kim BT, Kim SE (2003) Extratemporal hypometabolism on FDG PET in temporal lobe epilepsy as a predictor of seizure outcome after temporal lobectomy. Eur J Nucl Med Mol Imaging 30(4):581–587. https://doi.org/10.1007/s00259-002-1079-8CrossRefPubMed

23.

Wong CH, Bleasel A, Wen L, Eberl S, Byth K, Fulham M, Somerville E, Mohamed A (2010) The topography and significance of extratemporal hypometabolism in refractory mesial temporal lobe epilepsy examined by FDG-PET. Epilepsia 51(8):1365–1373. https://doi.org/10.1111/j.1528-1167.2010.02552.xCrossRefPubMed

24.

Gok B, Jallo G, Hayeri R, Wahl R, Aygun N (2013) The evaluation of FDG-PET imaging for epileptogenic focus localization in patients with MRI positive and MRI negative temporal lobe epilepsy. Neuroradiology 55(5):541–550. https://doi.org/10.1007/s00234-012-1121-xCrossRefPubMed

25.

Wong CH, Bleasel A, Wen L, Eberl S, Byth K, Fulham M, Somerville E, Mohamed A (2012) Relationship between preoperative hypometabolism and surgical outcome in neocortical epilepsy surgery. Epilepsia 53(8):1333–1340. https://doi.org/10.1111/j.1528-1167.2012.03547.xCrossRefPubMed

26.

Fong JS, Jehi L, Najm I, Prayson RA, Busch R, Bingaman W (2011) Seizure outcome and its predictors after temporal lobe epilepsy surgery in patients with normal MRI. Epilepsia 52(8):1393–1401. https://doi.org/10.1111/j.1528-1167.2011.03091.xCrossRefPubMed

27.

O’Brien TJ, So EL, Mullan BP, Hauser MF, Brinkmann BH, Bohnen NI, Hanson D, Cascino GD, Jack CR, Sharbrough FW (1998) Subtraction ictal SPECT co-registered to MRI improves clinical usefulness of SPECT in localizing the surgical seizure focus. Neurology 50(2):445–454. https://doi.org/10.1212/wnl.50.2.445CrossRefPubMed

28.

O’Brien TJ, So EL, Cascino GD, Hauser MF, Marsh WR, Meyer FB, Sharbrough FW, Mullan BP (2004) Subtraction SPECT coregistered to MRI in focal malformations of cortical development: localization of the epileptogenic zone in epilepsy surgery candidates. Epilepsia 45(4):367–376. https://doi.org/10.1111/j.0013-9580.2004.54703.xCrossRefPubMed

29.

Kumar A, Chugani HT (2013) The role of radionuclide imaging in epilepsy, part 1: sporadic temporal and extratemporal lobe epilepsy. J Nucl Med 54(10):1775–1781. https://doi.org/10.2967/jnumed.112.114397CrossRefPubMed

30.

La Fougère C, Rominger A, Förster S, Geisler J, Bartenstein P (2009) PET and SPECT in epilepsy: a critical review. Epilepsy Behav 15(1):50–55. https://doi.org/10.1016/j.yebeh.2009.02.025CrossRefPubMed

31.

Velasco RT, Wichert-Ana WL, Mathern MG, Araújo LD, Walz PR, Bianchin CM, Dalmagro AC, Leite GJ, Santos CA, Assirati CJ, Carlotti CC, Sakamoto CA (2011) Utility of ictal single photon emission computed tomography in mesial temporal lobe epilepsy with hippocampal atrophy: a randomized trial. Neurosurgery 68(2):431–436. https://doi.org/10.1227/NEU.0b013e318201c293CrossRefPubMed

32.

Jafari-Khouzani K, Elisevich K, Karvelis KC, Soltanian-Zadeh H (2011) Quantitative multi-compartmental SPECT image analysis for lateralization of temporal lobe epilepsy. Epilepsy Res 95(1–2):35–50. https://doi.org/10.1016/j.eplepsyres.2011.02.011CrossRefPubMedPubMedCentral

33.

Kudr M, Krsek P, Marusic P, Tomasek M, Trnka J, Michalova K, Jaruskova M, Sanda J, Kyncl M, Zamecnik J, Rybar J, Jahodova A, Mohapl M, Komarek V, Tichy M (2013) SISCOM and FDG-PET in patients with non-lesional extratemporal epilepsy: correlation with intracranial EEG, histology, and seizure outcome. Epileptic Disord 15(1):3–13. https://doi.org/10.1684/epd.2013.0560CrossRefPubMed

34.

Wetjen NM, Cascino GD, Fessler AJ, So EL, Buchhalter JR, Mullan BP, O’Brien TJ, Meyer FB, Marsh WR (2006) Subtraction ictal single-photon emission computed tomography coregistered to magnetic resonance imaging in evaluating the need for repeated epilepsy surgery. J Neurosurg 105(1):71–76. https://doi.org/10.3171/jns.2006.105.1.71CrossRefPubMed

35.

Jeong SW, Lee SK, Hong KS, Kim KK, Chung CK, Kim H (2005) Prognostic factors for the surgery for mesial temporal lobe epilepsy: longitudinal analysis. Epilepsia 46(8):1273–1279. https://doi.org/10.1111/j.1528-1167.2005.33504.xCrossRefPubMed

36.

Wichert-Ana L, Velasco TR, Terra-Bustamante VC, Araújo D, Júnior VA, Kato M, Leite JP, Assirati JA, MacHado HR, Bastos AC, Sakamoto AC (2001) Typical and atypical perfusion patterns in periictal SPECT of patients with unilateral temporal lobe epilepsy. Epilepsia 42(5):660–666. https://doi.org/10.1046/j.1528-1157.2001.41900.xCrossRefPubMed

37.

Yune MJ, Lee JD, Ryu YH, Kim DI, Lee BI, Kim SJ (1998) Ipsilateral thalamic hypoperfusion on interictal SPECT in temporal lobe epilepsy. J Nuclear Med 39(2):281–285

38.

Tae WS, Joo EY, Kim JH, Han SJ, Suh Y-L, Kim BT, Hong SC, Hong SB (2005) Cerebral perfusion changes in mesial temporal lobe epilepsy: SPM analysis of ictal and interictal SPECT. Neuroimage 24(1):101–110. https://doi.org/10.1016/j.neuroimage.2004.08.005CrossRefPubMed

39.

Castro LH, Serpa MH, Valério RM, Jorge CL, Ono CR, Arantes PR, Rosemberg S, Wen HT (2008) Good surgical outcome in discordant ictal EEG-MRI unilateral mesial temporal sclerosis patients. Epilepsia 49(8):1324–1332. https://doi.org/10.1111/j.1528-1167.2008.01714.xCrossRefPubMed

40.

Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, Sperling MR, Lüders H, Pedley TA, (ILAE) CoNotILAE (2001) ILAE Commission Report: proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 42(2):282–286PubMed

41.

Amorim BJ, Etchebehere EC, Camargo EE, Rio PA, Bonilha L, Rorden C, Li LM, Cendes F (2005) Statistical voxel-wise analysis of ictal SPECT reveals pattern of abnormal perfusion in patients with temporal lobe epilepsy. Arq Neuropsiquiatr 63(4):977–983. https://doi.org/10.1590/s0004-282x2005000600014CrossRefPubMed

42.

Shin WC, Hong SB, Tae WS, Seo DW, Kim SE (2001) Ictal hyperperfusion of cerebellum and basal ganglia in temporal lobe epilepsy: SPECT subtraction with MRI coregistration. J Nucl Med 42(6):853–858PubMed

43.

Savic I, Altshuler L, Baxter L, Engel J (1997) Pattern of interictal hypometabolism in PET scans with fludeoxyglucose F 18 reflects prior seizure types in patients with mesial temporal lobe seizures. Arch Neurol 54(2):129–136. https://doi.org/10.1001/archneur.1997.00550140011006CrossRefPubMed

44.

Arnold S, Schlaug G, Niemann H, Ebner A, Lüders H, Witte OW, Seitz RJ (1996) Topography of interictal glucose hypometabolism in unilateral mesiotemporal epilepsy. Neurology 46(5):1422–1430. https://doi.org/10.1212/wnl.46.5.1422CrossRefPubMed

45.

Rusu V, Chassoux F, Landré E, Bouilleret V, Nataf F, Devaux BC, Turak B, Semah F (2005) Dystonic posturing in seizures of mesial temporal origin: electroclinical and metabolic patterns. Neurology 65(10):1612–1619. https://doi.org/10.1212/01.wnl.0000184510.44808.50CrossRefPubMed

46.

Shin WC, Hong SB, Tae WS, Kim SE (2002) Ictal hyperperfusion patterns according to the progression of temporal lobe seizures. Neurology 58(3):373–380. https://doi.org/10.1212/wnl.58.3.373CrossRefPubMed

47.

Chassagnon S, Namer IJ, Armspach JP, Nehlig A, Kahane P, Kehrli P, Valenti MP, Hirsch E (2009) SPM analysis of ictal-interictal SPECT in mesial temporal lobe epilepsy: relationships between ictal semiology and perfusion changes. Epilepsy Res 85(2–3):252–260. https://doi.org/10.1016/j.eplepsyres.2009.03.020CrossRefPubMed

48.

DeSalvo MN, Tanaka N, Douw L, Cole AJ, Stufflebeam SM (2020) Contralateral preoperative resting-state functional MRI network integration is associated with surgical outcome in temporal lobe epilepsy. Radiology 294(3):622–627. https://doi.org/10.1148/radiol.2020191008CrossRefPubMed

49.

He X, Chaitanya G, Asma B, Caciagli L, Bassett DS, Tracy JI, Sperling MR (2020) Disrupted basal ganglia-thalamocortical loops in focal to bilateral tonic-clonic seizures. Brain 143(1):175–190. https://doi.org/10.1093/brain/awz361CrossRefPubMed

50.

Bell GS, de Tisi J, Gonzalez-Fraile JC, Peacock JL, McEvoy AW, Harkness WFJ, Foong J, Pope RA, Diehl B, Sander JW, Duncan JS (2017) Factors affecting seizure outcome after epilepsy surgery: an observational series. J Neurol Neurosurg Psychiatry 88(11):933–940. https://doi.org/10.1136/jnnp-2017-316211CrossRefPubMed

51.

Lieb JP, Dasheiff RM, Engel J (1991) Role of the frontal lobes in the propagation of mesial temporal lobe seizures. Epilepsia 32(6):822–837. https://doi.org/10.1111/j.1528-1157.1991.tb05539.xCrossRefPubMed

52.

Van Paesschen W, Dupont P, Van Driel G, Van Billoen H, Maes A (2003) SPECT perfusion changes during complex partial seizures in patients with hippocampal sclerosis. Brain 126(Pt 5):1103–1111. https://doi.org/10.1093/brain/awg108CrossRefPubMed

53.

Blumenfeld H, McNally KA, Vanderhill SD, Paige AL, Chung R, Davis K, Norden AD, Stokking R, Studholme C, Novotny EJ, Zubal IG, Spencer SS (2004) Positive and negative network correlations in temporal lobe epilepsy. Cereb Cortex 14(8):892–902. https://doi.org/10.1093/cercor/bhh048CrossRefPubMed

54.

Goffin K, Dedeurwaerdere S, Van Laere K, Van Paesschen W (2008) Neuronuclear assessment of patients with epilepsy. Semin Nucl Med 38(4):227–239. https://doi.org/10.1053/j.semnuclmed.2008.02.004CrossRefPubMed

55.

Benedek K, Juhász C, Chugani DC, Muzik O, Chugani HT (2006) Longitudinal changes in cortical glucose hypometabolism in children with intractable epilepsy. J Child Neurol 21(1):26–31. https://doi.org/10.1177/08830738060210011101CrossRefPubMed

56.

Nelissen N, Van Paesschen W, Baete K, Van Laere K, Palmini A, Van Billoen H, Dupont P (2006) Correlations of interictal FDG-PET metabolism and ictal SPECT perfusion changes in human temporal lobe epilepsy with hippocampal sclerosis. Neuroimage 32(2):684–695. https://doi.org/10.1016/j.neuroimage.2006.04.185CrossRefPubMed

57.

Morgan VL, Gore JC, Abou-Khalil B (2010) Functional epileptic network in left mesial temporal lobe epilepsy detected using resting fMRI. Epilepsy Res 88(2–3):168–178. https://doi.org/10.1016/j.eplepsyres.2009.10.018CrossRefPubMed

58.

Lee KH, Park YD, King DW, Meador KJ, Loring DW, Murro AM, Smith JW (2000) Prognostic implication of contralateral secondary electrographic seizures in temporal lobe epilepsy. Epilepsia 41(11):1444–1449. https://doi.org/10.1111/j.1528-1157.2000.tb00120.xCrossRefPubMed

Titel: Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy
verfasst von: Maarten Haemels
Donatienne Van Weehaeghe
Evy Cleeren
Patrick Dupont
Johan van Loon
Tom Theys
Koen Van Laere
Wim Van Paesschen
Karolien Goffin
Publikationsdatum: 05.02.2021
Verlag: Springer International Publishing
Erschienen in: Acta Neurologica Belgica / Ausgabe 2/2022
Print ISSN: 0300-9009
Elektronische ISSN: 2240-2993
DOI: https://doi.org/10.1007/s13760-020-01569-y

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