Brain Advance Access originally published online on July 28, 2004
Brain 2004 127(10):2276-2285; doi:10.1093/brain/awh257
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Brain Vol. 127 No. 10 © Guarantors of Brain 2004; all rights reserved
MRI-negative PET-positive temporal lobe epilepsy: a distinct surgically remediable syndrome
1 Victorian Epilepsy Centre, St Vincent's Hospital, 2 PET Centre, The Peter MacCallum Cancer Institute, 3 Departments of Neurology and Neurosurgery, St. Vincent's Hospital, 4 The Royal Melbourne Hospital, The University of Melbourne and Departments of Medicine and Surgery, 5 St. Vincent's Hospital and 6 The Royal Melbourne Hospital, 7 Department of Clinical Epidemiology and Biostatistics, The Royal Melbourne Hospital, 8 Department of Psychology, The University of Melbourne, Victoria, Australia
Correspondence to: Dr Ross Carne, Department of Clinical Neurosciences, Geelong Hospital, Level 2, Kardinia House, Bellerine St, Geelong, Victoria 3220, Australia E-mail: carnero{at}svhm.org.au
Most patients with non-lesional temporal lobe epilepsy (NLTLE) will have the findings of hippocampal sclerosis (HS) on a high resolution MRI. However, a significant minority of patients with NLTLE and electroclinically well-lateralized temporal lobe seizures have no evidence of HS on MRI. Many of these patients have concordant hypometabolism on fluorodeoxyglucose-PET ([18F]FDG-PET). The pathophysiological basis of this latter group remains uncertain. We aimed to determine whether NLTLE without HS on MRI represents a variant of or a different clinicopathological syndrome from that of NLTLE with HS on MRI. The clinical, EEG, [18F]FDG-PET, histopathological and surgical outcomes of 30 consecutive NLTLE patients with well-lateralized EEG but without HS on MRI (HS–ve TLE) were compared with 30 consecutive age- and sex-matched NLTLE patients with well-lateralized EEG with HS on MRI (HS+ve TLE). Both the HS+ve TLE group and the HS–ve TLE patients had a high degree of [18F]FDG-PET concordant lateralization (26 out of 30 HS–ve TLE versus 27 out of 27 HS+ve TLE). HS–ve TLE patients had more widespread hypometabolism on [18F]FDG-PET by blinded visual analysis [odds ratio (OR = +
(2.51, –), P = 0.001]. The HS–ve TLE group less frequently had a history of febrile convulsions [OR = 0.077 (0.002–0.512), P = 0.002], more commonly had a delta rhythm at ictal onset [OR = 3.67 (0.97–20.47), P = 0.057], and less frequently had histopathological evidence of HS [OR = 0 (0–0.85), P = 0.031]. There was no significant difference in surgical outcome despite half of those without HS having a hippocampal-sparing procedure. Based on the findings outlined, HS–ve PET-positive TLE may be a surgically remediable syndrome distinct from HS+ve TLE, with a pathophysiological basis that primarily involves lateral temporal neocortical rather than mesial temporal structures.
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