Gamma knife treatment for intractable epileptic psychogney through positron emission tomography localization

Abstract

Objective To study the stereotaxic Gamma knife treatment for intractable epileptic psychogney (EPP) through positron emission tomography (PET) localization and evaluate its efficacy.Methods PET examination based on 18F-Fluorodeoxyglucose (18F-FDG) was carried out on 45 patients with EPP to localize the epileptogenic foci with the help of amplitude-integrated electroencephalographic (aEEG) and MRI; the clinical characteristics,preoperative examinations and treatment effects of seizure and mental symptom of these patients were analyzed.Based on lesions and EPP types,the patients were divided into PEP group (n=25,patients with paroxysmal EPP [PEP] receiving gamma knife treatment of the epileptogenic foci) and NEP group (n=20,patients with nonprosysmal EPP [NEP]); patients in the NEP group were subdivided into NEPc group (n=16,patients with NEP receiving corpus callosotomy and frontal cingulectomy on the epileptogenic foci with gamma knife treatment) and NEPs group (n=4,patients with NEP performed stereotaxic nuclei lesion radiation by gamma knife on the deep brain only).Results Excellent rate for mental symptoms in the clinical global impression (CGI) scale reached 62.2％ in total; and that in PEP and NEPs groups was 72.0％ and 75％,respectively,which was markedly higher than that in NEPc group (43.8％).In all,62.2％ patients (28/45) reached Wieser grade Ⅰ-Ⅱ,and 20.0％ (9/45) Wieser grade Ⅲ-Ⅳ,with a total efficiency of 82.2％; and the efficiency rate in NEPs was 25％ (1/4),which was significantly lower than that in the PEP and NEPc groups (88.0％ and 87.5％,P＜0.05).Conclusion Intractable EPP could get good effect by gamma knife treatment; PEP patients can be treated by gamma knife on the epileptogenic foci and NEP patients by combined epileptogenic foci and stereotaxic nuclei lesion gamma knife radiation Key words: Epilepsy; Mental disorder; Stereotactic surgery; Gamma knife; Positron emission tomography