Multimodal Coregistration in Patients with Temporal Lobe Epilepsy--Results of Different Imaging Modalities in Lateralization of the Affected Hemisphere in MR Imaging Positive and Negative Subgroups

• Published in: American Journal of Neuroradiology 2007-03, Vol.28 (3), p.449-454
• Main Authors: Doelken, M.T, Richter, G, Stefan, H, Doerfler, A, Noemayr, A, Kuwert, T, Ganslandt, O, Nimsky, C.H, Hammen, T
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Brain; Cerebral Cortex - diagnostic imaging; Cerebral Cortex - pathology; Electroencephalography; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - pathology; Epilepsy, Temporal Lobe - surgery; Functional Laterality; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hippocampus - diagnostic imaging; Hippocampus - pathology; Human viral diseases; Humans; Infectious diseases; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Spectroscopy; Medical sciences; Nervous system; Nervous system (semeiology, syndromes); Neurology; Preoperative Care; Protons; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sclerosis; Tomography, Emission-Computed, Single-Photon; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0195-6108; 1936-959X; 1432-1920

In this study, intensive video electroencephalogram (EEG) monitoring, high-resolution MR imaging (MR imaging), proton MR spectroscopy ((1)H-MR spectroscopy) and single-photon emission CT (SPECT) were compared in patients with temporal lobe epilepsy (TLE) to evaluate lateralization of affected hemisphere with regard to bilateral affection and postoperative outcome. Recall ratio of each technique for indicating the affected hemisphere was determined in 49 patients with TLE. Postoperative outcome was established by Engel classification. Twenty-two of 25 patients with TLE with evidence for hippocampal sclerosis in MR imaging (MR imaging-positive) were graded as unilateral by EEG findings whereas 3 were classified as bilateral. Fourteen of 24 MR imaging-negative patients were graded as unilateral by EEG and 10 as bitemporal. (1)H-MR spectroscopy indicated concordant lateralization to EEG in 82% of MR imaging-positive patients and 71% of MR imaging-negative patients and to SPECT in 84% of MR imaging-positive patients and 67% of MR imaging-negative patients with TLE. In unilateral TLE, the concordance rate of both modalities was 74% in MR imaging-positive patients and 67% in MR imaging-negative patients. Contralateral findings to EEG focus were found in 28% by (1)H-MR spectroscopy and in 27% by SPECT. Concordant findings to the operated side of different modalities revealed a clear tendency (P = .08) for a better postoperative outcome compared with bitemporal or contralateral findings. Our data demonstrate that multimodal imaging in patients with TLE improves lateralization of affected hemispheres, especially in patients without pathologic findings in MR imaging, and indicates bilateral effect, which is important to identify patients who will benefit from surgery.