Research advances in positron emission tomography-computed tomography for etiological diagnosis, epileptogenic focus localization, and prognostic prediction of epilepsy treatment_Journal of Epilepsy

Authors：

XIANG Qi ^1,2 , HAN Tao ^1,2 , LIU Anru ^1,2 ,  LIU Xuewu ¹

1. Shandong University Qilu Medical College, Jinan 250012, China;
2. Department of Neurology, Shandong Provincial Hospital, Jinan 250021, China;

Corresponding author：

LIU Xuewu, Email: snlxw1966@163.com

Keywords：

Epilepsy; Etiological diagnosis; Epileptogenic focus localization; Positron emission tomography-computed tomography; Prognostic prediction of treatment; Epilepsy treatment

DOI：

10.7507/2096-0247.202310007

Video：

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Epilepsy is a clinical syndrome characterized by recurrent epileptic seizures caused by various etiologies. Etiological diagnosis and localization of the epileptogenic focus are of great importance in the treatment of epilepsy. Positron emission tomography-computed tomography (PET-CT) technology plays a significant role in the etiological diagnosis and localization of the epileptogenic focus in epilepsy. It also guides the treatment of epilepsy, predicts the prognosis, and helps physicians intervene earlier and improve the quality of life of patients. With the continuous development of PET-CT technology, more hope and better treatment options will be provided for epilepsy patients. This article will review the guiding role of PET-CT technology in the diagnosis and treatment of epilepsy, providing insights into its application in etiological diagnosis, preoperative assessment of the condition, selection of treatment plans, and prognosis of epilepsy.

Citation： XIANG Qi, HAN Tao, LIU Anru, LIU Xuewu. Research advances in positron emission tomography-computed tomography for etiological diagnosis, epileptogenic focus localization, and prognostic prediction of epilepsy treatment. Journal of Epilepsy, 2024, 10(2): 127-132. doi: 10.7507/2096-0247.202310007 Copy

1.	Balestrini Simona, Arzimanoglou Alexis, Blümcke Ingmar, et al. The aetiologies of epilepsy. Epileptic Disord, 2021, 23(1): 1-16.
2.	Scheffer Ingrid E, Berkovic Samuel, Capovilla Guiseppe, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 512-521.
3.	Thurman David J, Beghi Ettore, Begley Charles E. , et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 2011, 52(1): 2-26.
4.	Doruyter Alexander GG, Parkes Jeannette, Carr Jonathan, et al. PET-CT in brain disorders: The South African context. SA Journal of Radiology, 2021, 25(1): a2201.
5.	Lameka Katherine, Farwell Michael D, Ichise Masanori. Positron emission tomography. Handbook Clinical Neurology, 2016, 135: 209-227.
6.	Nieto-Salazar Maria A, Velasquez-Botero Felipe, Toro-Velandia Adriana C, et al. Diagnostic implications of neuroimaging in epilepsy and other seizure disorders. Annals of Medicine and Surgery, 2023, 85(2): 73-75.
7.	Zhao Zexian, Li Hong, Wang Shan, et al. Patterns of hypometabolism in frontal lobe epilepsy originating in different frontal regions. Annals of Clinical and Translational Neurology, 2022, 9(9): 1336-1344.
8.	Shin Hae W, Jewells Valerie, Sheikh Arif, et al. Initial experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure-European Journal of Epilepsy, 2015, 31: 1-4.
9.	Kong Y, Cheng N, Dang N, et al. Application of combined multimodal neuroimaging and video-electroencephalography in intractable epilepsy patients for improved post-surgical outcome prediction. Clinical Radiology, 2022, 77(3): e250-e259.
10.	Kini Lohith G, Thaker Ashesh A, Hadar Peter N, et al. Quantitative ^[18]FDG PET asymmetry features predict long-term seizure recurrence in refractory epilepsy. Epilepsy & Behavior, 2021, 116: 107714.
11.	Chen Wei, Silverman Daniel HS, Delaloye Sibyll, et al. 18F-FDOPA PET imaging of brain tumors: comparison study with 18F-FDG PET and evaluation of diagnostic accuracy. The Journal of Nuclear Medicine, 2006, 47(6): 904-911.
12.	Zhang Lingling, Hu Kuan, Shao Tuo, et al. Recent developments on PET radiotracers for TSPO and their applications in neuroimaging. Acta Pharmaceutica Sinica B, 2021, 11(2): 373-393.
13.	Sukprakun Chanan, Tepmongkol Supatporn. Nuclear imaging for localization and surgical outcome prediction in epilepsy: a review of latest discoveries and future perspectives. Frontiers in Neurology, 2022, 13: 1083775.
14.	Carvalho Marcela Santos, Alvim Marina Koutsodontis Machado, Etchebehere Elba, et al. Interictal and postictal (18)F-FDG PET/CT in epileptogenic zone localization. Radiologia Brasileira, 2022, 55(5): 273-279.
15.	Stevelink Remi, Campbell Ciarán, Chen Siwei, et al. GWAS meta-analysis of over 29, 000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nature Genetics, 2023, 55(9): 1471-1482.
16.	Annegers JF, Hauser WA, Beghi E, et al. The risk of unprovoked seizures after encephalitis and meningitis. Neurology, 1988, 38(9): 1407-1410.
17.	Singhi Pratibha. Infectious causes of seizures and epilepsy in the developing world. Developmental Medicine and Child Neurology, 2011, 53(7): 600-609.
18.	Vezzani Annamaria, Fujinami Robert S, White H Steve, et al. Infections, inflammation and epilepsy. Acta Neuropathologica, 2016, 131(2): 211-234.
19.	Tumiene Birute, Ferreira Carlos R, van Karnebeek Clara DM. 2022 overview of metabolic epilepsies. Genes, 2022, 13(3): 508.
20.	Stockler-Ipsiroglu Sylvia, Potter Beth K, Yuskiv Nataliya, et al. Developments in evidence creation for treatments of inborn errors of metabolism. Journal of Inherited Metabolic Disease, 2021, 44(1): 88-98.
21.	Toledano Michel, Britton JW, McKeon A, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology, 2014, 82(18): 1578-1586.
22.	Bien Christian G. Value of autoantibodies for prediction of treatment response in patients with autoimmune epilepsy: review of the literature and suggestions for clinical management. Epilepsia, 2013, 54: 48-55.
23.	Masangkay Neil, Basu Sandip, Moghbel Mateen, et al. Brain 18F-FDG-PET characteristics in patients with paraneoplastic neurological syndrome and its correlation with clinical and MRI findings. Nuclear Medicine Communications, 2014, 35(10): 1038-1046.
24.	Leypoldt Frank, Buchert Ralph, Kleiter Ingo, et al. Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. Journal of Neurology Neurosurgery and Psychiatry, 2012, 83(7): 681-686.
25.	Egesa Isaac J, Newton Charles RJC. , Kariuki Symon M. Evaluation of the International League Against Epilepsy 1981, 1989, and 2017 classifications of seizure semiology and etiology in a population-based cohort of children and adults with epilepsy. Epilepsia Open, 2022, 7(1): 98-109.
26.	Kumar Ananyaa, Alhourani Hani, Abdelkader Ahmed, et al. Frontal lobe hypometabolism associated with Sudden Unexpected Death in Epilepsy (SUDEP) risk: an objective PET study. Epilepsy & Behavior, 2021, 122: 108185.
27.	Zhang Di, Cui Xuehua, Zheng Jie, et al. A retrospective study of parietal lobe epilepsy: functional anatomy and surgical treatment. Alternative Therapies in Health and Medicine, 2022, 28(6): 138-143.
28.	Peter Jonah, Houshmand Sina, Werner Thomas J, et al. Applications of global quantitative 18F-FDG-PET analysis in temporal lobe epilepsy. Nuclear Medicine Communications, 2016, 37(3): 223-230.
29.	Naganawa Mika, Gallezot Jean-Dominique, Finnema Sjoerd J. , et al. Drug characteristics derived from kinetic modeling:combined 11C-UCB-J human PET imaging with levetiracetam and brivaracetam occupancy of SV2A. Ejnmmi Research, 2022, 12(1): 71.
30.	Kuzniecky RI. Neuroimaging in pediatric epilepsy. Epilepsia, 1996, 37: S10-S21.
31.	Fitsiori Aikaterini, Hiremath Shivaprakash Basavanthaiah, Boto Jose, et al. Morphological and advanced imaging of epilepsy: beyond the basics. Children-Basel, 2019, 6(3): 43.
32.	Bell Michael L, Rao Satish, So Elson L, et al. Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI. Epilepsia, 2009, 50(9): 2053-2060.
33.	Ji Taoyun, Liu Ming, Wang Shuang, et al. Seizure outcome and its prognostic predictors after hemispherotomy in children with refractory epilepsy in a chinese pediatric epileptic center. Frontiers in Neurology, 2019, 10: 880.
34.	Madaan Priyanka, Gupta Ajay, Gulati Sheffali. Pediatric epilepsy surgery: indications and evaluation. Indian Journal of Pediatrics, 2021, 88(10): 1000-1006.
35.	Nadkarni Tanvi, Dabir Aman, Niazi Faraze, et al. Drug-resistant high grade glioma-related epilepsy surgery for focal motor status epilepticus localized by CT-PET imaging. Epilepsy & Behavior Repprts, 2021, 16: 100484.
36.	Ilyas-Feldmann Maria, Vorderwülbecke Bernd, Steinbrenner Mirja. Imaging in the presurgical evaluation of epilepsy. Nervenarzt, 2022, 93(6): 592-598.
37.	Peedicail Joseph Samuel, Singh Shaily, Molnar Christine P, et al. Impact of ictal subtraction SPECT and PET in presurgical evaluation. Acta Neurologica Scandinavica, 2021, 143(3): 271-280.
38.	Jolles Paul R, Chapman Peter R, Alavi Abass. PET, CT, and MRI in the evaluation of neuropsychiatric disorders: current applications. Journal of Nuclear Medicine, 1989, 30(10): 1589-1606.
39.	Inaji Motoki, Maehara Taketoshi. PET, SPECT, and MEG in the diagnosis of epilepsy. Nihon Rinsho. Japanese Journal of Clinical Medicine, 2014, 72(5): 827-833.

1. Balestrini Simona, Arzimanoglou Alexis, Blümcke Ingmar, et al. The aetiologies of epilepsy. Epileptic Disord, 2021, 23(1): 1-16.
2. Scheffer Ingrid E, Berkovic Samuel, Capovilla Guiseppe, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017, 58(4): 512-521.
3. Thurman David J, Beghi Ettore, Begley Charles E. , et al. Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia, 2011, 52(1): 2-26.
4. Doruyter Alexander GG, Parkes Jeannette, Carr Jonathan, et al. PET-CT in brain disorders: The South African context. SA Journal of Radiology, 2021, 25(1): a2201.
5. Lameka Katherine, Farwell Michael D, Ichise Masanori. Positron emission tomography. Handbook Clinical Neurology, 2016, 135: 209-227.
6. Nieto-Salazar Maria A, Velasquez-Botero Felipe, Toro-Velandia Adriana C, et al. Diagnostic implications of neuroimaging in epilepsy and other seizure disorders. Annals of Medicine and Surgery, 2023, 85(2): 73-75.
7. Zhao Zexian, Li Hong, Wang Shan, et al. Patterns of hypometabolism in frontal lobe epilepsy originating in different frontal regions. Annals of Clinical and Translational Neurology, 2022, 9(9): 1336-1344.
8. Shin Hae W, Jewells Valerie, Sheikh Arif, et al. Initial experience in hybrid PET-MRI for evaluation of refractory focal onset epilepsy. Seizure-European Journal of Epilepsy, 2015, 31: 1-4.
9. Kong Y, Cheng N, Dang N, et al. Application of combined multimodal neuroimaging and video-electroencephalography in intractable epilepsy patients for improved post-surgical outcome prediction. Clinical Radiology, 2022, 77(3): e250-e259.
10. Kini Lohith G, Thaker Ashesh A, Hadar Peter N, et al. Quantitative ^[18]FDG PET asymmetry features predict long-term seizure recurrence in refractory epilepsy. Epilepsy & Behavior, 2021, 116: 107714.
11. Chen Wei, Silverman Daniel HS, Delaloye Sibyll, et al. 18F-FDOPA PET imaging of brain tumors: comparison study with 18F-FDG PET and evaluation of diagnostic accuracy. The Journal of Nuclear Medicine, 2006, 47(6): 904-911.
12. Zhang Lingling, Hu Kuan, Shao Tuo, et al. Recent developments on PET radiotracers for TSPO and their applications in neuroimaging. Acta Pharmaceutica Sinica B, 2021, 11(2): 373-393.
13. Sukprakun Chanan, Tepmongkol Supatporn. Nuclear imaging for localization and surgical outcome prediction in epilepsy: a review of latest discoveries and future perspectives. Frontiers in Neurology, 2022, 13: 1083775.
14. Carvalho Marcela Santos, Alvim Marina Koutsodontis Machado, Etchebehere Elba, et al. Interictal and postictal (18)F-FDG PET/CT in epileptogenic zone localization. Radiologia Brasileira, 2022, 55(5): 273-279.
15. Stevelink Remi, Campbell Ciarán, Chen Siwei, et al. GWAS meta-analysis of over 29, 000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nature Genetics, 2023, 55(9): 1471-1482.
16. Annegers JF, Hauser WA, Beghi E, et al. The risk of unprovoked seizures after encephalitis and meningitis. Neurology, 1988, 38(9): 1407-1410.
17. Singhi Pratibha. Infectious causes of seizures and epilepsy in the developing world. Developmental Medicine and Child Neurology, 2011, 53(7): 600-609.
18. Vezzani Annamaria, Fujinami Robert S, White H Steve, et al. Infections, inflammation and epilepsy. Acta Neuropathologica, 2016, 131(2): 211-234.
19. Tumiene Birute, Ferreira Carlos R, van Karnebeek Clara DM. 2022 overview of metabolic epilepsies. Genes, 2022, 13(3): 508.
20. Stockler-Ipsiroglu Sylvia, Potter Beth K, Yuskiv Nataliya, et al. Developments in evidence creation for treatments of inborn errors of metabolism. Journal of Inherited Metabolic Disease, 2021, 44(1): 88-98.
21. Toledano Michel, Britton JW, McKeon A, et al. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology, 2014, 82(18): 1578-1586.
22. Bien Christian G. Value of autoantibodies for prediction of treatment response in patients with autoimmune epilepsy: review of the literature and suggestions for clinical management. Epilepsia, 2013, 54: 48-55.
23. Masangkay Neil, Basu Sandip, Moghbel Mateen, et al. Brain 18F-FDG-PET characteristics in patients with paraneoplastic neurological syndrome and its correlation with clinical and MRI findings. Nuclear Medicine Communications, 2014, 35(10): 1038-1046.
24. Leypoldt Frank, Buchert Ralph, Kleiter Ingo, et al. Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. Journal of Neurology Neurosurgery and Psychiatry, 2012, 83(7): 681-686.
25. Egesa Isaac J, Newton Charles RJC. , Kariuki Symon M. Evaluation of the International League Against Epilepsy 1981, 1989, and 2017 classifications of seizure semiology and etiology in a population-based cohort of children and adults with epilepsy. Epilepsia Open, 2022, 7(1): 98-109.
26. Kumar Ananyaa, Alhourani Hani, Abdelkader Ahmed, et al. Frontal lobe hypometabolism associated with Sudden Unexpected Death in Epilepsy (SUDEP) risk: an objective PET study. Epilepsy & Behavior, 2021, 122: 108185.
27. Zhang Di, Cui Xuehua, Zheng Jie, et al. A retrospective study of parietal lobe epilepsy: functional anatomy and surgical treatment. Alternative Therapies in Health and Medicine, 2022, 28(6): 138-143.
28. Peter Jonah, Houshmand Sina, Werner Thomas J, et al. Applications of global quantitative 18F-FDG-PET analysis in temporal lobe epilepsy. Nuclear Medicine Communications, 2016, 37(3): 223-230.
29. Naganawa Mika, Gallezot Jean-Dominique, Finnema Sjoerd J. , et al. Drug characteristics derived from kinetic modeling:combined 11C-UCB-J human PET imaging with levetiracetam and brivaracetam occupancy of SV2A. Ejnmmi Research, 2022, 12(1): 71.
30. Kuzniecky RI. Neuroimaging in pediatric epilepsy. Epilepsia, 1996, 37: S10-S21.
31. Fitsiori Aikaterini, Hiremath Shivaprakash Basavanthaiah, Boto Jose, et al. Morphological and advanced imaging of epilepsy: beyond the basics. Children-Basel, 2019, 6(3): 43.
32. Bell Michael L, Rao Satish, So Elson L, et al. Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI. Epilepsia, 2009, 50(9): 2053-2060.
33. Ji Taoyun, Liu Ming, Wang Shuang, et al. Seizure outcome and its prognostic predictors after hemispherotomy in children with refractory epilepsy in a chinese pediatric epileptic center. Frontiers in Neurology, 2019, 10: 880.
34. Madaan Priyanka, Gupta Ajay, Gulati Sheffali. Pediatric epilepsy surgery: indications and evaluation. Indian Journal of Pediatrics, 2021, 88(10): 1000-1006.
35. Nadkarni Tanvi, Dabir Aman, Niazi Faraze, et al. Drug-resistant high grade glioma-related epilepsy surgery for focal motor status epilepticus localized by CT-PET imaging. Epilepsy & Behavior Repprts, 2021, 16: 100484.
36. Ilyas-Feldmann Maria, Vorderwülbecke Bernd, Steinbrenner Mirja. Imaging in the presurgical evaluation of epilepsy. Nervenarzt, 2022, 93(6): 592-598.
37. Peedicail Joseph Samuel, Singh Shaily, Molnar Christine P, et al. Impact of ictal subtraction SPECT and PET in presurgical evaluation. Acta Neurologica Scandinavica, 2021, 143(3): 271-280.
38. Jolles Paul R, Chapman Peter R, Alavi Abass. PET, CT, and MRI in the evaluation of neuropsychiatric disorders: current applications. Journal of Nuclear Medicine, 1989, 30(10): 1589-1606.
39. Inaji Motoki, Maehara Taketoshi. PET, SPECT, and MEG in the diagnosis of epilepsy. Nihon Rinsho. Japanese Journal of Clinical Medicine, 2014, 72(5): 827-833.

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