Abstract
Objective This study was designed to use statistical parametric mapping (SPM) of preoperative interictal FDG-PET to compare the brain metabolisms of patients with mesial temporal lobe epilepsy/hippocampal sclerosis (MTLE/HS) who underwent resective surgery and controls. Another aim of this study was to analyze potential differences in SPM-PET within the group of MTLE/HS patients in terms of gender, side of HS, histopathological findings, and postoperative outcomes. Methods We analyzed FDG-PET scans from 49 patients with MTLE/HS and 24 control subjects. Using SPM, we analyzed the differences in regional glucose metabolism between the patient and the control groups and within the patient group using multiple variables. Results We revealed widespread hypometabolism in the patient group in comparison to the control group in temporal and extratemporal areas on the epileptogenic side (ES). On the nonepileptogenic side (NES), we observed most the hypometabolism in the thalamus and the anterior and middle cingulate gyri (GCA and GCM). In the group of patients with more severe HS (Wyler III/IV), we observed statistically significant hypometabolism in the insula on the ES in comparison to the patients with Wyler I/II HS. In patients with poor postoperative outcomes (ILAE III-V), we found statistically significant hypometabolism in the insula on the ES and the TP on the NES compared to the ILAE I and II group. Patients with encephalitis/meningoencephalitis and/or febrile seizures in their history showed significant hypermetabolism in the TP either on the ES or the NES and in the middle temporal gyrus on the NES compared to the patients without any insult in their history. Significance Our study showed that there are widespread significant changes in metabolism in MTLE/HS patients in comparison to controls, either inside or outside the temporal lobe and mostly ipsilateral to the side of HS. There are significant differences among these patients in terms of postoperative outcomes, degree of HS, and insults in their history.
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