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From the Department of Biological Psychiatry (Drs. Rubin and Moeller), Columbia University/New York State Psychiatric Institute, New York, NY; the Department of Neurology (Drs. Dhawan, Takikawa, and Eidelberg), North Shore University Hospital/Cornell University Medical College, Manhasset, NY; the Department of Neurology (Dr. Labar), New York Hospital/Cornell University Medical College, New York, NY; and Long Island Jewish Hospital (Drs. Schaul and Barr), New Hyde Park, NY.
Supported in part by The Epilepsy Foundation of America and by NIMH Grant T32-MH15144.
Received November 16, 1994. Accepted in final form March 28, 1995.
Address correspondence and reprint requests to Dr. D. Eidelberg, Department of Neurology, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030.
Objective: Fluorodeoxyglucose positron emission tomography (FDG-PET) studies of temporal lobe epilepsy (TLE) generally report interictal hypometabolism in the vicinity of the seizure focus. Yet, other evidence suggests that interictal metabolic abnormalities might extend to remote brain areas. We used FDG-PET to evaluate metabolism in selected regions distant from the focus in TLE. Subjects: Twenty adult patients with medically intractable TLE were selected by criteria favoring a unilateral mesiobasal temporal focus. Structural imaging in this sample was normal except for medial temporal sclerosis in 13 patients. Twenty normal volunteers were controls. Design: PET imaging was performed interictally. Regional glucose metabolism normalized by global metabolism was analyzed using t tests and correlation analysis. Results: Ipsilateral to the seizure focus, metabolism was depressed compared with normal in the temporal pole (p equals 0.001), but relatively elevated in the mesiobasal region (p equals 0.005). Contralateral to the focus, metabolism was elevated in lateral temporal cortex (p equals 0.0003) and mesiobasal regions (p equals 0.0001). Metabolic correlation between ipsilateral and contralateral mesiobasal regions was similar in normal subjects (r equals 0.74) and patients (r equals 0.68). In contrast, correlations were abnormal between temporal poles and other temporal lobe subregions, both ipsilateral and contralateral to the seizure focus. Conclusions: Relative to normal values, both elevations and depressions of metabolism exist interictally in TLE. Such abnormalities, and accompanying changes in interregional correlations, may have wide spatial distribution. These findings are atypical among PET studies but are consistent with other physiologic, anatomic, and neuropsychological investigations of TLE.
NEUROLOGY 1995;45: 2212-2223
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