내측두엽 간질에서 간질 수술이 뇌 포도당 대사에 미치는 영향
The Statistical Parametric Mapping Analysis between Pre - and Post-Operative FDG-PET Image in Patients with Mesial Temporal Lobe Epilepsy
한현정, 주은연, 태우석, 김지현, 한선정, 서대원, 홍성철, 이문향, 김병태, 홍승봉,
소속 상세정보
한현정 ( Han Hyun-Jeong )
관동대학교 의과대학 신경과학교실
주은연 ( Joo Eun-Yeon )
성균관대학교 의과대학 삼성서울병원 신경과학교실
태우석 ( Tae Woo-Suk )
성균관대학교 의과대학 삼성서울병원 신경과학교실
김지현 ( Kim Jee-Hyun )
성균관대학교 의과대학 삼성서울병원 신경과학교실
한선정 ( Han Sun-Jung )
성균관대학교 의과대학 삼성서울병원 신경과학교실
서대원 ( Seo Dae-Won )
성균관대학교 의과대학 삼성서울병원 신경과
홍성철 ( Hong Seung-Chyul )
성균관대학교 의과대학 삼성서울병원 신경외과학교실
이문향 ( Lee Mun-Hyang )
성균관대학교 의과대학 삼성서울병원 소아청소년과
김병태 ( Kim Byung-Tae )
성균관대학교 의과대학 삼성서울병원 핵의학과
홍승봉 ( Hong Seung-Bong )
성균관대학교 의과대학 삼성서울병원 신경과학교실
KMID : 0877220050090010027
Abstract
Background: To investigate postoperative changes in the cerebral glucose metabolism of patients with mesial temporal lobe epilepsy (MTLE), statistical parametric mapping (SPM) analysis was performed on pre- and post-operative 18F-fluorodeoxy glucose positron emission tomographic (FDG-PET) images.
Methods: We included 28 patients with MTLE who had under-gone surgery and had been seizure free postoperatively (16 had left MTLE and 12 right MTLE). All patients showed hippocampal sclerosis by pathology or brain MRI. FDG-PET images of the 12 right TLE patients were reversed to lateralize the epileptogenic zone to the left side in all patients.
Results: Application of the paired t-test in SPM to pre- and postoperative FDG-PETs showed that the postoperative glucose metabolism decreased in the caudate nucleus, pulvinar of thalamus, fusiform gyrus, lingual gyrus, and in the posterior region of the insular cortex in the hemisphere ipsilateral to resection, whereas postoperative glucose metabolism increased in the anterior region of the insular cortex, temporal stem white matter, midbrain, inferior precentral gyrus, anterior cingulate gyrus, and supramarginal gyrus in the hemisphere ipsilateral to resection. No significant postsurgical changes of cerebral glucose metabolism occurred in the contralateral hemisphere. Subtraction between pre- and postoperative FDG-PET images in individual patients produced similar findings to the SPM results.
Conclusion: This study suggests that brain regions showing a postoperative increase in glucose metabolism appear to represent the propagation pathways of ictal and interictal epileptic discharges in MTLE while a postoperative decrease in glucose metabolism may be related to a permanent loss of afferents from resected anterior-mesial temporal structures.
키워드
Temporal Lobe Epilepsy;Metabolism; Anterior temporal lobectomy
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