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The Significance of Insular Hypometabolism in Temporal Lobe Epilepsy in Children

Authors
 Ji Ae Hur  ;  Joon Won Kang  ;  Hoon-Chul Kang  ;  Heung Dong Kim  ;  Jeong Tae Kim  ;  Joon Soo Lee 
Citation
 Journal of Epilepsy Research, Vol.3(2) : 54-62, 2013 
Journal Title
 Journal of Epilepsy Research 
ISSN
 2233-6249 
Issue Date
2013
Keywords
Epilepsy ; Insular ; PET ; Pediatric ; Post-operative outcome ; Surgery
Abstract
BACKGROUND AND PURPOSE: Temporal lobe epilepsy is one of the most common forms of medically refractory epileptic syndromes. In a small percentage, temporal lobectomy fails to control the seizures in patients with epilepsy of clear temporal origin, and in some of these patients, seizures originating from the insular cortex is believed to be the cause behind the surgical failures. We retrospectively analyzed the [(18)F]FDG-positron emission tomography (PET) results of patients who received temporal lobe surgery for presence of insular hypometabolism, and compared the surgical outcome to verify whether insular hypometablism was related with difference in post-operative results. METHODS: 13 patients were enrolled, and clinical variables, post-operative pathology, magnetic resonance imaging and PET results were analyzed for possible differences between the patients with or without insular hypometabolism. RESULTS: 7 patients showed insular hypometabolism, while 6 patients were clear of insular lesion on PET exam. 8 patients received anterior temporal lobectomy with amygdalohippocampectomy (AH), 2 patients received radical temporal lobectomy with AH, and 3 patients received insular cortisectomy. Post-operative results were favorable in 8 patients and unfavorable in 5, with unfavorable outcomes in all recipients of insular cortisectomy. Presence of insular hypometabolism did not have any significant relationship with the post-surgical outcome (p=0.266), but its trend showed a tendency towards favorable outcome if insular hypometabolism was not present. CONCLUSIONS: Presence of insular hypometabolism in [(18)F]FDG-PET analysis was not significantly correlated with the post-operative outcome, and recipients of insular cortisectomy among our patients with insular hypometabolism resulted in poor surgical outcome. However, the outcome trend showed a tendency towards better surgical outcome with absence of hypometabolic lesion in the ipsilateral insular cortex. Further studies employing a larger patient group is needed.
Files in This Item:
T201305942.pdf Download
DOI
10.14581/jer.13011
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Joon Won(강준원)
Kang, Hoon Chul(강훈철) ORCID logo https://orcid.org/0000-0002-3659-8847
Kim, Heung Dong(김흥동) ORCID logo https://orcid.org/0000-0002-8031-7336
Lee, Joon Soo(이준수) ORCID logo https://orcid.org/0000-0001-9036-9343
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89308
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