PET and SPECT in Insular Epilepsy

doi:10.1017/9781108772396.016

Chapter 15 - PET and SPECT in Insular Epilepsy

from Section 3 - Noninvasive Investigation of Insular Epilepsy

Published online by Cambridge University Press: 09 June 2022

Francine Chassoux and

Edited by

Jean Isnard and

Dang Nguyen: Affiliation:
Université de Montréal
Jean Isnard: Affiliation:
Claude Bernard University Lyon
Philippe Kahane: Affiliation:
Grenoble-Alpes University Hospital

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Summary

Functional imaging has been reported to have a limited impact in the diagnosis of insular epilepsies, showing unspecific or misleading features. However, recent studies have demonstrated that PET and SPECT may be helpful in identifying abnormalities pointing to insula and guiding invasive monitoring. FDG-PET may detect a focal or regional hypometabolism in about half of the cases, and its localization value is greatly improved by the coregistration with MRI. In addition, PET may help lateralize the insular seizures, and statistical analysis contributes to differentiate them from temporal and frontal lobe seizures. SEEG strategy benefits from PET findings, as electrode implantation within the main hypometabolic areas improves the concordance rate between the PET pattern and the localization of the epileptogenic zone. Finally, PET is a reliable tool for the detection of insular focal cortical dysplasias, especially in MRI negative cases. These findings are helpful for planning surgery in these difficult-to-treat epilepsies. SPECT regional cerebral blood flow (rCBF) imaging under both interictal and ictal conditions is a mainstay of localization of epileptogenic foci in subjects with medically intractable epilepsy contemplating surgical ablation of disease-causing focal brain anomalies. Its performance is excellent in patients with mesial temporal lobe epilepsy, but neocortical foci remain harder to evaluate, in particular because of their tendency to generalize more rapidly than the former. The specific case of insular epilepsy has been studied in a limited number of studies only, reporting on a few tens of patients overall. Although this limits the possibility of conducting well-powered statistical analysis of the sensitivity and specificity of interictal/ictal SPECT rCBF imaging in this condition, available results converge towards the conclusion that this technique offers useful and important information in the pre-operative assessment of patients afflicted by that often difficult to characterize disease.

Keywords

PET SPECT SISCOM hypometabolism hyperperfusion

Type: Chapter
Information: Insular Epilepsies , pp. 179 - 193

DOI: https://doi.org/10.1017/9781108772396.016 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2022

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