Surgical decision making in temporal lobe epilepsy: A comparison of [18F]FDG-PET, MRI, and EEG

ObjectivesThe goals of this work were (1) to determine the effect of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET), MRI, and EEG on the decision to perform temporal lobe epilepsy (TLE) surgery, and (2) to determine if FDG-PET, MRI, or EEG predicts surgical outcome.MethodsAll PET scans ordered (2000-2010) for epilepsy or seizures were tabulated. Medical records were investigated to determine eligibility and collect data. Statistical analysis included odds ratios, κ statistics, univariate analysis, and logistic regression.ResultsOf the 186 patients who underwent FDG-PET, 124 had TLE, 50 were surgical candidates, and 34 had surgery with post-operative follow-up. Median length of follow-up was 24 months. MRI, FDG-PET, and EEG were significant predictors of surgical candidacy (P < 0.001) with odds ratios of 42.8, 20.4, and 6.3, respectively. FDG-PET was the only significant predictor of postoperative outcome (P < 0.01).ConclusionMRI showed a trend toward having the most influence on surgical candidacy, but only FDG-PET predicted surgical outcome.

► The records of patients who underwent FDG-PET for temporal lobe epilepsy were reviewed. ► Modeled surgical candidacy and surgical outcomes were based on PET, MRI, and EEG results. ► Of the 124 subjects who had TLE, 34 subjects underwent temporal lobe epilepsy surgery with a median follow-up of 24 months. ► MRI results affected surgical candidacy the most (odds ratio = 42.8), followed by PET (20.4) and EEG (6.3). ► FDG-PET was the only significant predictor of postoperative outcome (P = 0.04).