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Periventricular [(11)C]flumazenil binding for predicting postoperative outcome in individual patients with temporal lobe epilepsy and hippocampal sclerosis.

Yankam Njiwa J, Bouvard S, Catenoix H, Mauguiere F, Ryvlin P, Hammers A - Neuroimage Clin (2013)

Bottom Line: In individuals and at optimized cutoffs, five (63%) of eight NSF patients and one (13%) of eight SF patients showed periventricular increases compared with controls (accuracy 75%).Only one (2%) of the 41 controls had increases at the same cutoff.The association between periventricular [(11)C]FMZ increases and NSF outcome after temporal lobe resection for HS has been confirmed in an independent cohort on simple summed activity images. [(11)C]FMZ-PET may be useful for individual preoperative counseling with clinically relevant accuracy.

View Article: PubMed Central - PubMed

Affiliation: Neurodis Foundation, Lyon, France.

ABSTRACT
A third of patients with intractable temporal lobe epilepsy and hippocampal sclerosis (HS) are not seizure free (NSF) after surgery. Increased periventricular [(11)C]flumazenil (FMZ) binding, reflecting heterotopic neuron concentration, has been described as one predictor of NSF outcome at the group level. We aimed to replicate this finding in an independent larger cohort and investigated whether NSF outcome can be predicted in individuals. Preoperative [(11)C]FMZ summed radioactivity images were available for 16 patients with HS and 41 controls. Images were analyzed using SPM8, explicitly including the white matter, and correction for global radioactivity via group-specific ANCOVA. Periventricular increases were assessed with a mask and different cutoffs for distinguishing NSF and seizure free (SF) patients. NSF patients had increased [(11)C]FMZ binding around the posterior horn of the ventricles ipsilaterally (z = 2.53) and contralaterally (z = 4.44) to the seizure focus compared with SF patients. Compared with controls, SF patients had fewer periventricular increases (two clusters, total volume 0.87 cm(3), zmax = 3.8) than NSF patients (two ipsilateral and three contralateral clusters, 6.15 cm(3), zmax = 4.8). In individuals and at optimized cutoffs, five (63%) of eight NSF patients and one (13%) of eight SF patients showed periventricular increases compared with controls (accuracy 75%). Only one (2%) of the 41 controls had increases at the same cutoff. The association between periventricular [(11)C]FMZ increases and NSF outcome after temporal lobe resection for HS has been confirmed in an independent cohort on simple summed activity images. [(11)C]FMZ-PET may be useful for individual preoperative counseling with clinically relevant accuracy.

No MeSH data available.


Related in: MedlinePlus

Periventricular increases. Statistical results, visualized at p < 0.01, overlaid on the SPM8 T1-weighted template. All results are unmasked and therefore clusters outside of the periventricular mask used for statistical assessment are also shown. Left on the image is ipsilateral to the side of surgery. Clusters with highest z-scores observed within the periventricular mask are highlighted with green arrows. The notation CE stands for cluster extent. Color bar, t scores. (a) Increases in patients with suboptimal outcome (not Engel class IA), compared to controls (zmax = 5.3 ipsilaterally (CE = 3 cm3) and zmax = 4.3 contralaterally (CE = 2.2 cm3)). (b) Patients with Engel class IA outcome have far less important periventricular increases compared to controls (zmax = 3.3, CE = 0.3 cm3). (c) Increases in patients not Engel IA compared to seizure-free patients; contralateral (zmax = 4.2,m CE = 0.9 cm3) and ipsilateral (zmax = 2.7, CE = 0.56 cm3). This is the same comparison as in the cohort in Hammers et al. (2005). (d) Periventricular increases in an individual patient with suboptimal outcome, posterior to the ipsilateral lateral ventricle (zmax = 4.0, CE = 3.0 cm3).
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f0005: Periventricular increases. Statistical results, visualized at p < 0.01, overlaid on the SPM8 T1-weighted template. All results are unmasked and therefore clusters outside of the periventricular mask used for statistical assessment are also shown. Left on the image is ipsilateral to the side of surgery. Clusters with highest z-scores observed within the periventricular mask are highlighted with green arrows. The notation CE stands for cluster extent. Color bar, t scores. (a) Increases in patients with suboptimal outcome (not Engel class IA), compared to controls (zmax = 5.3 ipsilaterally (CE = 3 cm3) and zmax = 4.3 contralaterally (CE = 2.2 cm3)). (b) Patients with Engel class IA outcome have far less important periventricular increases compared to controls (zmax = 3.3, CE = 0.3 cm3). (c) Increases in patients not Engel IA compared to seizure-free patients; contralateral (zmax = 4.2,m CE = 0.9 cm3) and ipsilateral (zmax = 2.7, CE = 0.56 cm3). This is the same comparison as in the cohort in Hammers et al. (2005). (d) Periventricular increases in an individual patient with suboptimal outcome, posterior to the ipsilateral lateral ventricle (zmax = 4.0, CE = 3.0 cm3).

Mentions: NSF patients had higher FMZ binding than seizure free patients around the posterior horn of the ventricles ipsilaterally to the seizure focus at threshold p < 0.01 (maximum z = 2.7) and contralaterally (maximum z = 4.2). We thus replicated the findings in our previous study (Hammers et al., 2005). In addition, in the present sample some clusters were located around the anterior horns (see Fig. 1(c)).


Periventricular [(11)C]flumazenil binding for predicting postoperative outcome in individual patients with temporal lobe epilepsy and hippocampal sclerosis.

Yankam Njiwa J, Bouvard S, Catenoix H, Mauguiere F, Ryvlin P, Hammers A - Neuroimage Clin (2013)

Periventricular increases. Statistical results, visualized at p < 0.01, overlaid on the SPM8 T1-weighted template. All results are unmasked and therefore clusters outside of the periventricular mask used for statistical assessment are also shown. Left on the image is ipsilateral to the side of surgery. Clusters with highest z-scores observed within the periventricular mask are highlighted with green arrows. The notation CE stands for cluster extent. Color bar, t scores. (a) Increases in patients with suboptimal outcome (not Engel class IA), compared to controls (zmax = 5.3 ipsilaterally (CE = 3 cm3) and zmax = 4.3 contralaterally (CE = 2.2 cm3)). (b) Patients with Engel class IA outcome have far less important periventricular increases compared to controls (zmax = 3.3, CE = 0.3 cm3). (c) Increases in patients not Engel IA compared to seizure-free patients; contralateral (zmax = 4.2,m CE = 0.9 cm3) and ipsilateral (zmax = 2.7, CE = 0.56 cm3). This is the same comparison as in the cohort in Hammers et al. (2005). (d) Periventricular increases in an individual patient with suboptimal outcome, posterior to the ipsilateral lateral ventricle (zmax = 4.0, CE = 3.0 cm3).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814949&req=5

f0005: Periventricular increases. Statistical results, visualized at p < 0.01, overlaid on the SPM8 T1-weighted template. All results are unmasked and therefore clusters outside of the periventricular mask used for statistical assessment are also shown. Left on the image is ipsilateral to the side of surgery. Clusters with highest z-scores observed within the periventricular mask are highlighted with green arrows. The notation CE stands for cluster extent. Color bar, t scores. (a) Increases in patients with suboptimal outcome (not Engel class IA), compared to controls (zmax = 5.3 ipsilaterally (CE = 3 cm3) and zmax = 4.3 contralaterally (CE = 2.2 cm3)). (b) Patients with Engel class IA outcome have far less important periventricular increases compared to controls (zmax = 3.3, CE = 0.3 cm3). (c) Increases in patients not Engel IA compared to seizure-free patients; contralateral (zmax = 4.2,m CE = 0.9 cm3) and ipsilateral (zmax = 2.7, CE = 0.56 cm3). This is the same comparison as in the cohort in Hammers et al. (2005). (d) Periventricular increases in an individual patient with suboptimal outcome, posterior to the ipsilateral lateral ventricle (zmax = 4.0, CE = 3.0 cm3).
Mentions: NSF patients had higher FMZ binding than seizure free patients around the posterior horn of the ventricles ipsilaterally to the seizure focus at threshold p < 0.01 (maximum z = 2.7) and contralaterally (maximum z = 4.2). We thus replicated the findings in our previous study (Hammers et al., 2005). In addition, in the present sample some clusters were located around the anterior horns (see Fig. 1(c)).

Bottom Line: In individuals and at optimized cutoffs, five (63%) of eight NSF patients and one (13%) of eight SF patients showed periventricular increases compared with controls (accuracy 75%).Only one (2%) of the 41 controls had increases at the same cutoff.The association between periventricular [(11)C]FMZ increases and NSF outcome after temporal lobe resection for HS has been confirmed in an independent cohort on simple summed activity images. [(11)C]FMZ-PET may be useful for individual preoperative counseling with clinically relevant accuracy.

View Article: PubMed Central - PubMed

Affiliation: Neurodis Foundation, Lyon, France.

ABSTRACT
A third of patients with intractable temporal lobe epilepsy and hippocampal sclerosis (HS) are not seizure free (NSF) after surgery. Increased periventricular [(11)C]flumazenil (FMZ) binding, reflecting heterotopic neuron concentration, has been described as one predictor of NSF outcome at the group level. We aimed to replicate this finding in an independent larger cohort and investigated whether NSF outcome can be predicted in individuals. Preoperative [(11)C]FMZ summed radioactivity images were available for 16 patients with HS and 41 controls. Images were analyzed using SPM8, explicitly including the white matter, and correction for global radioactivity via group-specific ANCOVA. Periventricular increases were assessed with a mask and different cutoffs for distinguishing NSF and seizure free (SF) patients. NSF patients had increased [(11)C]FMZ binding around the posterior horn of the ventricles ipsilaterally (z = 2.53) and contralaterally (z = 4.44) to the seizure focus compared with SF patients. Compared with controls, SF patients had fewer periventricular increases (two clusters, total volume 0.87 cm(3), zmax = 3.8) than NSF patients (two ipsilateral and three contralateral clusters, 6.15 cm(3), zmax = 4.8). In individuals and at optimized cutoffs, five (63%) of eight NSF patients and one (13%) of eight SF patients showed periventricular increases compared with controls (accuracy 75%). Only one (2%) of the 41 controls had increases at the same cutoff. The association between periventricular [(11)C]FMZ increases and NSF outcome after temporal lobe resection for HS has been confirmed in an independent cohort on simple summed activity images. [(11)C]FMZ-PET may be useful for individual preoperative counseling with clinically relevant accuracy.

No MeSH data available.


Related in: MedlinePlus