Presurgical epilepsy localization with interictal cerebral dysfunction

Research output: Contribution to journalReview article

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Abstract

Localization of interictal cerebral dysfunction with 2-[18F]fluoro-2-D-deoxyglucose (FDG) positron emission tomography (PET) and neuropsychological examination usefully supplements electroencephalography (EEG) and brain magnetic resonance imaging (MRI) in planning epilepsy surgery. In MRI-negative mesial temporal lobe epilepsy, correlation of temporal lobe hypometabolism with extracranial ictal EEG can support resection without prior intracranial EEG monitoring. In refractory localization-related epilepsies, hypometabolic sites may supplement other data in hypothesizing likely ictal onset zones in order to intracranial electrodes for ictal recording. Prognostication of postoperative seizure freedom with FDG PET appears to have greater positive than negative predictive value. Neuropsychological evaluation is critical to evaluating the potential benefit of epilepsy surgery. Cortical deficits measured with neuropsychometry are limited in lateralizing and localizing value for determination of ictal onset sites, however. Left temporal resection risks iatrogenic verbal memory deficits and dysnomia, and neuropsychological findings are useful in predicting those at greatest risk. Prognostication of cognitive risks with resection at other sites is less satisfactory.

Original languageEnglish (US)
Pages (from-to)194-208
Number of pages15
JournalEpilepsy and Behavior
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2011

Keywords

  • Epilepsy surgery
  • Fluorodeoxyglucose
  • Neuropsychology
  • Neuropsychometry
  • Positron emission tomography

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