Advertisement

Assessment of the role of FDG PET in the diagnosis and management of children with refractory epilepsy

  • Glenn P. Ollenberger
  • Amanda J. Byrne
  • Salvatore U. Berlangieri
  • Christopher C. Rowe
  • Kunthi Pathmaraj
  • David C. Reutens
  • Samuel F. Berkovic
  • Ingrid E. Scheffer
  • Andrew M. ScottEmail author
Original Article

Abstract

Purpose

We performed a retrospective analysis of the results of FDG PET scans in children with refractory epilepsy referred to our centre over an 8-year period, with a view to ascertaining the impact of FDG PET on subsequent patient management.

Methods

A questionnaire was used to assess the impact of FDG PET scan on diagnosis, management and clinical decision-making processes for epilepsy surgery from the managing clinician’s perspective. FDG PET scan results were also compared with MRI, EEG and SPECT results and coded according to whether the FDG PET scan provided independent information and localisation of epileptogenic regions.

Results

A total of 118 eligible patients under the age of 14 years were identified, with questionnaires being completed on 113 evaluable patients (96%). The pre-PET management plan consisted of consideration for surgery in 92 patients (81%) and medical therapy for the remaining 21 patients (19%). Managing physicians rated FDG PET as providing information additional to that obtained with other investigations regarding epileptogenic sites in 88 patients (77%). FDG PET had either a minor or a major impact on clinical management in 58 patients (51%), principally with regard to surgical candidacy.

Conclusion

FDG PET has a definite role in the assessment of paediatric patients with refractory epilepsy who are being considered for surgery. In the future, analysis of FDG PET data in specific subpopulations of children with refractory epilepsy may lead to novel insights regarding aetiology.

Keywords

Positron Emission Tomography Refractory Epilepsy Standard Investigation Epileptogenic Zone Epileptogenic Region 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We would like to acknowledge the contributions made to this study by Dr. Simon Harvey, the staff members of the Centre for PET and the EEG technologists involved in the patient studies.

References

  1. 1.
    Hauser WA, Hesdorffer DC. Epidemiology of intractable epilepsy. In: Lüders HO, Comair YG, editors. Epilepsy surgery. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 55–9Google Scholar
  2. 2.
    Sander JW. Some aspects of prognosis in the epilepsies: a review. Epilepsia 1993;38:1245–50Google Scholar
  3. 3.
    Farwell JR, Dodrill CB, Batzell LW. Neuropsychological abilities of children with epilepsy. Epilepsia 1985;26:395–400PubMedCrossRefGoogle Scholar
  4. 4.
    Bjornaes H, Stabell K, Henriksen O, Loyning Y. The effects of refractory epilepsy on intellectual functioning in children and adults. A longitudinal study. Seizure 2001;10:250–9PubMedCrossRefGoogle Scholar
  5. 5.
    Donner EJ, Smith CR, Snead OC. Sudden unexplained death in children with epilepsy. Neurology 2001;57:430–4PubMedCrossRefGoogle Scholar
  6. 6.
    Breningstall GN. Mortality in pediatric epilepsy. Pediatr Neurol 2001;25:9–16PubMedCrossRefGoogle Scholar
  7. 7.
    Wyllie E, Comair YG, Kotagal P, Bulacio J, Bingaman W, Ruggieri P. Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol 1998;44:740–8PubMedCrossRefGoogle Scholar
  8. 8.
    Engel JJ. Surgery for seizures. N Engl J Med 1996;334:647–52PubMedCrossRefGoogle Scholar
  9. 9.
    Casse R, Rowe CC, Newton M, Berlangieri SU, Berkovic S, Scott AM. Positron emission tomography and epilepsy. J Mol Imag Biol 2002;4:338–51CrossRefGoogle Scholar
  10. 10.
    Salanova V, Markand O, Worth R, Garg B, Patel H, Asconape J, et al. Presurgical evaluation and surgical outcome of temporal lobe epilepsy. Pediatr Neurol 1999;20:179–84PubMedCrossRefGoogle Scholar
  11. 11.
    Chugani HT, Rintahaka P, Shewmon DA. Ictal patterns of cerebral glucose utilization in children with epilepsy. Epilepsia 1993;35:813–22CrossRefGoogle Scholar
  12. 12.
    Hamacher K, Coenen HH, Stocklin G. Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. J Nucl Med 1986;27:235–8PubMedGoogle Scholar
  13. 13.
    Won HJ, Chang KH, Cheon JE, Kim HD, Lee DS, Han MH, et al. Comparison of MR imaging with PET and ictal SPECT in 118 patients with intractable epilepsy. Am J Neuroradiol 1999;20:593–9PubMedGoogle Scholar
  14. 14.
    Gaillard WD, White S, Malow B, Flamini R, Weinstein S, Sato S, et al. FDG-PET in children and adolescents with partial seizures: role in epilepsy surgery evaluation.Epilepsy Res 1995;20:77–84PubMedCrossRefGoogle Scholar
  15. 15.
    Gopalan D, Griffiths D, Townsend C, Prvulovich E, Bomanji J, Costa DC, et al. Fluorodeoxyglucose positron emission tomography in clinical oncology: the referrer’s perspective. Nucl Med Commun 2002;23:1041–6PubMedCrossRefGoogle Scholar
  16. 16.
    Ryvlin P, Bouvard S, Le Bars D, De Lamerie G, Gregoire MC, Kahane P, et al. Clinical utility of flumazenil-PET versus [18F]fluorodeoxyglucose-PET and MRI in refractory epilepsy: a prospective study in 100 patients. Brain 1998;121:2067–81PubMedCrossRefGoogle Scholar
  17. 17.
    Seltzer MA, Yap CS, Silverman DH, Meta J, Schiepers C, Phelps ME, et al. The impact of PET on the management of lung cancer: the referring physician’s perspective. J Nucl Med 2002;43:752–6PubMedGoogle Scholar
  18. 18.
    Meta J, Seltzer M, Schiepers C, Silverman DH, Ariannejad M, Gambhir SS, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician’s perspective. J Nucl Med 2001;42:586–90PubMedGoogle Scholar
  19. 19.
    Cartwright A. Professionals as responders: variations in and effects of response rates to questionnaires, 1961–77. Br J Med 1978;2:1419–21CrossRefGoogle Scholar
  20. 20.
    Wyllie E, Comair YG, Kotagal P, Bulacio J, Bingaman W, Ruggieri P. Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol 1998;44:740–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Glenn P. Ollenberger
    • 1
  • Amanda J. Byrne
    • 1
  • Salvatore U. Berlangieri
    • 1
  • Christopher C. Rowe
    • 1
    • 3
  • Kunthi Pathmaraj
    • 1
  • David C. Reutens
    • 2
    • 3
  • Samuel F. Berkovic
    • 2
    • 3
  • Ingrid E. Scheffer
    • 2
    • 3
  • Andrew M. Scott
    • 1
    • 3
    • 4
    Email author
  1. 1.Department of Nuclear Medicine and Centre for PETUniversity of MelbourneMelbourneAustralia
  2. 2.Department of NeurologyUniversity of MelbourneMelbourneAustralia
  3. 3.Department of MedicineUniversity of MelbourneMelbourneAustralia
  4. 4.Ludwig Institute for Cancer ResearchAustin HospitalHeidelbergAustralia

Personalised recommendations