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Neurological Department (Drs. Hajek, Wieser, Khan, and Leenders), University Hospital Zürich, Switzerland; Paul Scherrer Institute (Drs. Hajek, Khan, Antonini, Beer, and Leenders, and P. Maguire), Villigen, Switzerland; and ZUMA Mannheim (Dr. Schrott), Center for Surveys, Methods, and Analyses, Mannheim, Germany.
We have studied 25 patients with interictal 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) before and after selective surgery for temporal lobe epilepsy (TLE). Based on the findings of the presurgical evaluation, including ictal intracranial EEGs, histopathologic findings, and the postoperative outcome, we classified the patients in three subgroups: (1) patients with TLE of lateral temporal origin (n = 5), (2) patients with mesiobasal limbic TLE associated with mesial gliosis (n = 14), and (3) patients with mesiobasal limbic TLE and small mesial tumors (n = 6). Postoperatively, patients with mesiobasal limbic TLE and mesial gliosis and five of six patients with mesiobasal limbic TLE and mesial tumors were seizure-free; the remaining sixth patient had one generalized seizure. Patients with TLE of lateral temporal origin had more than 90% reduction of seizure frequency. The main postoperative metabolic findings were as follows: (1) marked increase of regional cerebral metabolic rate of glucose (rCMRglu), both in the ipsilateral and, significantly, in the contralateral hemisphere in patients with mesiobasal limbic TLE and mesial gliosis–the changes of brain metabolism were characteristic for patients with the syndrome of "mesial temporal lobe epilepsy" (MTLE); (2) decrease of rCMRglu values in the contralateral mesiobasal temporal lobe (TL) cortex in all patient groups–the reduction of rCMRglu in homologous brain structures contralateral to the operated side provides evidence for stronger interhemispheric connections between both mesial TL structures than were hitherto supposed; and (3) a trend toward a normalization of rCMRglu values in the ipsilateral temporal neocortex 12 months after surgery in patients with MTLE syndrome.
Address correspondence and reprint requests to Dr. Klaus L. Leenders, Paul Scherrer Institute, PET Department, CH-5232 Villigen PSI, Switzerland.
Supported by "Swiss National Research Foundation" (grant number 31-25697.88). Dr. Hajek's work was partially supported by "Sanofi Winthrop Stiftung für Epilepsieforschung."
Received November 18, 1993. Accepted in final form April 29,1994.
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