Abstract Details

Title Frontal Lobe Glucose Hypometabolism in Patients with High Risk for Sudden Unexplained Death in Epilepsy (SUDEP): An Objective PET Study

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S59 - Epilepsy/Clinical Neurophysiology (EEG) 4 (1:24 PM-1:36 PM)

Poster/Presentation
Number 003

Objective To determine specific patterns of objectively-detected brain glucose metabolic abnormalities in patients with refractory focal epilepsy identified as having high risk for sudden unexplained death in epilepsy (SUDEP).

Background Common abnormal brain structures and neuronal networks have been identified in MRI studies of patients with SUDEP and those at elevated risk for SUDEP. In a pilot [¹⁸F]fluoro-deoxy-glucose positron emission tomography (FDG-PET) study we reported frontal lobe hypometabolism in four patients who subsequently suffered SUDEP (J Neurol Sci 2017 (381): 155).

Design/Methods

Patients with refractory epilepsy were assessed for their risk of SUDEP using the revised SUDEP-7 inventory. All patients underwent video-EEG monitoring, clinical MRI, and FDG-PET scanning as a part of their presurgical evaluation. Patients with large multilobar structural lesions were excluded. A voxel-based analysis of FDG-PET scans was performed using statistical parametric mapping (SPM). FDG-PET abnormalities were evaluated in two subgroups: those with high (SUDEP-7 score ≥5) vs. those with low SUDEP risk (score <5) as compared to FDG-PET scans of a healthy adult control group.

Results A total of 80 patients with refractory epilepsy (45 females, age: 16-61 years, mean: 37±12 years) were included in the PET analysis. SUDEP-7 inventory score was calculated at closest encounter to FDG-PET and ranged from 0 to 10 (mean: 3.6±2.0). MRI was normal in 40 patients. SPM analysis of the subgroup with high SUDEP risk (score ≥5, n=22) showed both lateral and medial frontal lobe hypometabolism as a common pattern, with maximum abnormalities in the right frontal cortex (present at p<0.05, family-wise error-corrected). The low-risk group (n=58) showed no specific common metabolic abnormalities on SPM group analysis.

Conclusions These data show that right frontal lobe involvement on FDG-PET, including the medial frontal cortex, may be a common metabolic pattern associated with high SUDEP risk in patients with refractory focal epilepsy.

Authors/Disclosures
PRESENTER	No disclosure on file
Hani Alhourani	No disclosure on file
Csaba Juhasz, MD (University Health Center)	The institution of Dr. Juhasz has received research support from NIH.
Maysaa M. Basha, MD, FAAN (Wayne State University, Detroit Medical Center)	Dr. Basha has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai.

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