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Prognosis of children with partial epilepsy

MRI and serial ¹⁸FDG-PET

From the Clinical Epilepsy Section, NINDS, Division of Intramural Research (W.D.G., S. Fazilat, S. Fazilat, P.R.-T., W.H.T.), and the Department of Neurology, Children's National Medical Center (W.D.G., S.W., J.C., P.L.P., L.G.V.), Washington, DC.

Address correspondence and reprint requests to Dr. William D. Gaillard, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010; e-mail: wgaillar{at}cnmc.org

Objective: To study the evolution of cerebral glucose metabolism after partial seizure onset in children, and its relation to clinical variables.

Methods: Thirty-eight children had 3.4 ±.8 ¹⁸FDG-PET scans over 3.0 ± 1.3 years starting within a year after their third unprovoked partial seizure. ¹⁸FDG-PET was analyzed with a region of interest template to measure normalized metabolism in 12 paired anatomic areas. Scans with absolute asymmetry index, |AI|, greater than 0.13 in at least one cortical region other than the cerebellum were considered abnormal. Standard clinical T1- and T2-weighted MRI (1.5 T) scans were obtained.

Results: Patients with initial normal PET (n = 28) were significantly more likely to remain in good seizure control than those with abnormal initial PET. Patients with initially normal PET scans that became abnormal had longer epilepsy duration before the first PET scan, but not greater seizure frequency, than those with PET always normal. There was no evidence for progression of hypometabolism. Patients with shorter time since last seizure and higher seizure frequency were more likely to have abnormal PET scans. Six of the seven patients whose PET scans were always abnormal had poor seizure control. Febrile seizure history did not affect PET findings. MRI was strongly predictive of initial PET results (² = 13.1; p < 0.02) but did not predict fluctuation hypometabolism. A model combining MRI and initial PET was strongly predictive of clinical course.

Conclusions: Initial imaging studies can help predict clinical course for children who have had at least three partial seizures. Serial FDG-PET is affected by seizure frequency and time since last seizure.

William D. Gaillard received funding from NIH NINDS K08 NS01663.

Disclosure: The authors report no conflicts of interest.

Received March 22, 2006.

Accepted in final form October 13, 2006.

This article has been cited by other articles:

				Prognostic Value of MRI and FDG-PET in Children with Partial Epilepsy Journal Watch Neurology, May 8, 2007; 2007(508): 3 - 3. [Full Text]