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Relationship between PET metabolism and SEEG epileptogenicity in focal lesional epilepsy

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Abstract

Purpose

This study aims to evaluate the performance of 18F-FDG PET for distinguishing the epileptogenic zone (EZ) from propagation and non-involved zones at brain area level, as defined using stereo-EEG (SEEG), in patients with pharmacoresistant epilepsy due to malformations of cortical development (MCD). Additionally, we seek to determine the relationship between 18F-FDG-PET data and post-surgical seizure outcome.

Methods

Thirty-eight patients with MCD were explored with 18F-FDG PET and SEEG. We compared PET metabolism of each patient to a control population of healthy subjects. Based on MRI and SEEG, we separated 4 distinct zones at individual level: lesional, epileptogenic non-lesional, propagation, and non-involved. Then, we analysed (1) difference of PET metabolism within these four distinct zones; (2) performance of PET in defining the EZ within the SEEG-sampled areas; and (3) relation between extension of PET hypometabolism and post-surgical seizure outcome.

Results

We found (1) a gradient of PET hypometabolism from non-involved to propagation, then to epileptogenic and lesional zones (p < 0.001); (2) good performance of PET in defining the EZ (AUC of ROC curve = 0.82); (3) poorer post-surgical prognosis associated with PET hypometabolism extension beyond SEEG sampling (p = 0.024).

Conclusion

18F-FDG-PET has good accuracy in determining EZ in patients with MCD even if the hypometabolism is not limited to the EZ. Furthermore, hypometabolic extension is unfavourably associated with post-surgical prognosis.

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Acknowledgements

We thank Prof. Figarella-Branger for the reviewing of histological data. We thank Prof. Patrick Chauvel, Prof. Martine Gavaret, Dr. Francesca Bonini, Dr. Lisa Vaugier, Dr. Francesca Pizzo, Dr. Sandrine Aubert, Dr. Geraldine Daquin, Dr. Nathalie Villeneuve and Dr. Anne Lepine (Marseille), for the clinical management of some included patients. We thank Prof. Henry Dufour for surgical procedures and Prof. Jean Régis for SEEG procedures, in some of the selected patients.

Funding

This work has been carried out within the FHU EPINEXT and DHU-Imaging with the support of the A*MIDEX project (ANR-11-IDEX-0001-02) funded by the “Investissements d’Avenir” French Government program managed by the French National Research Agency (ANR). Part of this work was funded by a joint Agence Nationale de la Recherche (ANR) and Direction Génerale de l’Offre de Santé (DGOS) under grant “VIBRATIONS” ANR-13-PRTS-0011-01.

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Authors and Affiliations

  1. Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Epileptology Department, Marseille, France

    Stanislas Lagarde, Aileen McGonigal, Agnès Trebuchon & Fabrice Bartolomei

  2. Aix Marseille Univ, EA 3279 CEReSS - Health Service Research and Quality of Life Center, Marseille, France

    Mohamed Boucekine & Laurent Boyer

  3. Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Functional and Stereotactic Neurosurgery Department, Marseille, France

    Romain Carron

  4. Aix Marseille Univ, APHM, INSERM, INS, Inst Neurosci Syst, Timone Hospital, Pediatric Neurosurgery Department, Marseille, France

    Didier Scavarda

  5. APHM, Timone Hospital, Pediatric Neurology Department, Marseille, France

    Mathieu Milh

  6. APHM, Timone Hospital, Nuclear Medicine Department, Marseille, France

    Eric Guedj

  7. Aix-Marseille Univ, CNRS, Ecole Centrale Marseille, UMR 7249, Institut Fresnel, Marseille, France

    Eric Guedj

  8. Aix-Marseille Univ, CERIMED, Marseille, France

    Eric Guedj

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  1. Stanislas Lagarde
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  2. Mohamed Boucekine
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  3. Aileen McGonigal
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  4. Romain Carron
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  9. Fabrice Bartolomei
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  10. Eric Guedj
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Contributions

Stanislas Lagarde, Fabrice Bartolomei and Eric Guedj participated in the Conceptualization and the Methodology of this study.

Stanislas Lagarde, Mohamed Boucekine, Laurent Boyer, Agnes Trebuchon, Romain Carron, Didier Scavarda, Mahtieu Milh, Aileen McGonigal, Fabrice Bartolomei and Eric Guedj participated in the Investigation and the Formal analysis.

Stanislas Lagarde, Mohamed Boucekine, Laurent Boyer, Agnes Trebuchon, Romain Carron, Didier Scavarda, Mahtieu Milh, Aileen McGonigal, Fabrice Bartolomei and Eric Guedj participated in the writing—review & editing.

Corresponding author

Correspondence to Eric Guedj.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (French Institute of Health (IRB15226)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Lagarde, S., Boucekine, M., McGonigal, A. et al. Relationship between PET metabolism and SEEG epileptogenicity in focal lesional epilepsy. Eur J Nucl Med Mol Imaging 47, 3130–3142 (2020). https://doi.org/10.1007/s00259-020-04791-1

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