Medicine (RMH) - Theses
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ItemThe role of 18FDG-PET in predicting seizure outcomes and memory deficits following an anterior temporal lobe resection for drug resistant epilepsy( 2020)Successful epilepsy surgery transforms the lives of patients with drug-resistant epilepsy. Yet, the seizure recurrence seen in a significant proportion of patients calls for improved selection of surgical candidates. The findings of this study, focusing on the role of 18FDG-PET as a metabolic predictor of memory deficits and seizure outcomes in patients with drug-resistant mesial temporal lobe epilepsy (MTLE) following an anterior temporal lobe resection, demonstrated the laterality-specific differentiality of metabolic patterns, with significantly higher rates of bitemporal hypometabolism observed in right MTLE patients heralding a 5-fold increased risk of postoperative seizure recurrence, whereas left MTLE patients exhibited more extensive ipsitemporal hypometabolism. While the real-world clinical utility of 18FDG-PET in predicting memory deficits in patients with MTLE is limited, the study findings suggest the need for further research into the role of impaired arbitrary learning as a potential biomarker of bitemporal epileptic network involvement in patients with right MTLE as well as the need for using task-specific neurocognitive markers in the evaluation of epilepsy surgery candidates. Lastly, while the extent of the postoperative gliosis was not associated with late seizure recurrence, time-related postoperative changes could offer further insights into the role of glial astrocytes in epileptogenesis and neuroprotection. The study findings enhance our understanding of laterality specific epileptic networks and have the distinct potential to advance patient care by influencing the selection of surgical candidates and assisting with preoperative patient counselling.