Epilepsia · 2025
Brain 18F-fluorodeoxyglucose positron emission tomography: An efficient tool at the initial diagnosis of nonlesional late onset epilepsy.
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Puisieux Salomé, Heyer Sébastien, Forthoffer Natacha, Doyen Matthieu, Tyvaert Louise, Verger Antoine
Аннотация
OBJECTIVE: This study evaluates the diagnostic performance and prognostic value of brain 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) at the initial diagnosis of patients with nonlesional late onset epilepsy (NLLOE).
METHODS: In this cohort study at the University Hospital of Nancy, France, newly diagnosed NLLOE patients, >50 years old, were consecutively included from June 2017 to January 2021 and systematically underwent brain 18F-FDG PET. They were categorized into four presumed etiological NLLOE subtypes: neurodegenerative subtype (NDS; patients with a diagnosis of neurodegenerative disease), microvascular subtype (MVS; patients with ≥3 cardiovascular risk factors and ≥2 vascular lesions on magnetic resonance imaging), inflammatory subtype (IFS; patients meeting international criteria for encephalitis), and unlabeled subtype (ULS). A systematic patient follow-up (at least 2 years) allowed assessment of cognitive outcomes under antiseizure medication by comparing for each patient the proportion of preserved/altered scores between initial and second neuropsychological assessment. Brain 18F-FDG PET was analyzed using a combined visual and semiquantitative approach at the individual level.
RESULTS: Eighty-seven patients were included (NDS, n = 18; MVS, n = 22; IFS, n = 7; ULS, n = 40). A normal 18F-FDG PET was observed in 46% of patients, with the final diagnosis of 88% of these patients excluding a neurodegenerative or inflammatory disorder. 18F-FDG PET had a negative predictive value of 94% for a cognitive decline at follow-up, similar for the overall population (n = 71) and the ULS population (n = 32). Moreover, a PET hypometabolic pattern suggestive of a neurodegenerative disorder was indicative of cognitive decline at follow-up in 74% of cases.
SIGNIFICANCE: 18F-FDG PET as part of the initial diagnosis of NLLOE patients may have a significant impact on both NLLOE diagnosis and cognitive prognosis. For almost half of NLLOE patients, a normal 18F-FDG PET could help to exclude neurodegenerative and inflammatory epilepsy etiologies as well as future cognitive decline.
METHODS: In this cohort study at the University Hospital of Nancy, France, newly diagnosed NLLOE patients, >50 years old, were consecutively included from June 2017 to January 2021 and systematically underwent brain 18F-FDG PET. They were categorized into four presumed etiological NLLOE subtypes: neurodegenerative subtype (NDS; patients with a diagnosis of neurodegenerative disease), microvascular subtype (MVS; patients with ≥3 cardiovascular risk factors and ≥2 vascular lesions on magnetic resonance imaging), inflammatory subtype (IFS; patients meeting international criteria for encephalitis), and unlabeled subtype (ULS). A systematic patient follow-up (at least 2 years) allowed assessment of cognitive outcomes under antiseizure medication by comparing for each patient the proportion of preserved/altered scores between initial and second neuropsychological assessment. Brain 18F-FDG PET was analyzed using a combined visual and semiquantitative approach at the individual level.
RESULTS: Eighty-seven patients were included (NDS, n = 18; MVS, n = 22; IFS, n = 7; ULS, n = 40). A normal 18F-FDG PET was observed in 46% of patients, with the final diagnosis of 88% of these patients excluding a neurodegenerative or inflammatory disorder. 18F-FDG PET had a negative predictive value of 94% for a cognitive decline at follow-up, similar for the overall population (n = 71) and the ULS population (n = 32). Moreover, a PET hypometabolic pattern suggestive of a neurodegenerative disorder was indicative of cognitive decline at follow-up in 74% of cases.
SIGNIFICANCE: 18F-FDG PET as part of the initial diagnosis of NLLOE patients may have a significant impact on both NLLOE diagnosis and cognitive prognosis. For almost half of NLLOE patients, a normal 18F-FDG PET could help to exclude neurodegenerative and inflammatory epilepsy etiologies as well as future cognitive decline.