Abstract Details

Title The Utility of 18-FDG PET Neuroimaging in the Preoperative Workup for Epilepsy Surgery; Real World Experiences from an Irish Tertiary Referral Centre

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-001

Objective To assess the clinical utility of 18-FDG-PET neuroimaging in the epilepsy presurgical workup in cases where MR imaging is normal.

Background

For patients with refractory focal epilepsy, surgical resection of the epileptogenic zone can achieve a dramatic improvement in seizure control. However, many patients who may be eligible for epilepsy surgery may never be referred due to the lack of a clear surgical target on MRI. More recently, 18-FDG-PET neuroimaging has been employed as an adjunct to MRI and EEG-telemetry to select patients for epilepsy surgery.

Design/Methods This retrospective study used the database for the Epilepsy Monitoring Unit at Cork University Hospital to derive the results the investigation findings (MRI and EEG telemetry) and surgical outcomes of all patients who underwent 18-FDG-PET neuroimaging as part of their presurgical workup between January 2015 and March 2020.

Results

1. Between 2015 and 2020, 65/90 patients who underwent a workup for epilepsy surgery had 18-FDG-PET neuroimaging.

2. In total, 33/65 (40.7%) cases had normal MRIs, of whom 17/33 (51%) had focal hypometabolism on 18-FDG PET. Therefore, over half our cohort with "non-lesional" epilepsy were able to proceed to further monitoring or epilepsy surgery using supportive data from 18-FDG-PET.

3. Of 35 patients who underwent epilepsy surgery, 28 (80%) had a supportive 18-FDG-PET study, including 10 patients (28%) who had normal MRIs.

4. Out of 21 patients who had unilateral temporal hypometabolism preoperatively, 17 (81%) achieved freedom from generalised seizures (81%).

Conclusions 18-FDG PET neuroimaging can correctly identify the epileptogenic lesion in a significant proportion of patients with "non-lesional" focal epilepsy (over 50% of our cohort). These patients can go on to have successful epilepsy surgery based on 18-FDG-PET and EEG data alone. Unilateral temporal hypometabolism on 18-FDG-PET is predictive of a good surgical outcome and can be used to counsel patients on the likelihood of surgical success.

Authors/Disclosures
Sarah Wrigley, MD PRESENTER	Dr. Wrigley has nothing to disclose.
Daniel Costello, MD	Dr. Costello has nothing to disclose.

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