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01-04-2022 | Epilepsy | Original article

Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy

Authors: Maarten Haemels, Donatienne Van Weehaeghe, Evy Cleeren, Patrick Dupont, Johan van Loon, Tom Theys, Koen Van Laere, Wim Van Paesschen, Karolien Goffin

Published in: Acta Neurologica Belgica | Issue 2/2022

Abstract

The value of functional molecular changes outside the seizure onset zone as independent predictive factors of surgical outcome has been scarcely evaluated. The aim of this retrospective study was to evaluate relative metabolic and perfusion changes outside the seizure onset zone as predictors of postoperative outcome in patients with unifocal refractory focal epilepsy. Eighty-six unifocal epilepsy patients who underwent ¹⁸F‐FDG PET prior to surgery were included. Ictal and interictal perfusion SPECT was available in 65 patients. Good postoperative outcome was defined as the International League against Epilepsy class 1. Using univariate statistical analysis, the predictive ability of volume-of-interest based relative metabolism/perfusion for outcome classification was quantified by AUC ROC-curve, using composite, unilateral cortical (frontal, orbitofrontal, temporal, parietal, occipital) and central volumes-of-interest. The results were cross-validated, and a false discovery rate (FDR) correction was applied. As a secondary objective, a subgroup analysis was performed on temporal lobe epilepsy patients (N = 64). Increased relative ictal perfusion in the contralateral central volume-of-interest was significantly associated with the good surgical outcome both in the total population (AUC 0.79, p_FDR = 0.009) and the temporal lobe epilepsy subgroup (AUC 0.80, p_FDR = 0.028). No other significant associations between functional molecular changes and postoperative outcome were found. Increased relative ictal perfusion in the contralateral central region significantly predicted outcome after epilepsy surgery in patients with refractory focal epilepsy. We postulate that these relative perfusion changes could be an expression of better preoperative neuronal network integration and centralization in the contralateral central structures, which is suggested to be associated with better postoperative outcome.

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Title: Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy
Authors: Maarten Haemels
Donatienne Van Weehaeghe
Evy Cleeren
Patrick Dupont
Johan van Loon
Tom Theys
Koen Van Laere
Wim Van Paesschen
Karolien Goffin
Publication date: 01-04-2022
Publisher: Springer International Publishing
Keywords: Epilepsy
Positron Emission Tomography
Published in: Acta Neurologica Belgica / Issue 2/2022
Print ISSN: 0300-9009
Electronic ISSN: 2240-2993
DOI: https://doi.org/10.1007/s13760-020-01569-y

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Predictive value of metabolic and perfusion changes outside the seizure onset zone for postoperative outcome in patients with refractory focal epilepsy

Abstract

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Abstract

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