Postoperative seizure freedom is another possible gold standard t

Postoperative seizure freedom is another possible gold standard that also raises a http://www.selleckchem.com/products/ABT-888.html number of issues, such as the time elapsed between surgery and the last follow-up, the postoperative management of AED regimen, the quality of the selleckbio surgical procedure, and the complex process through which an investigation might interact with the surgical strategy. Last but not least, there is a great heterogeneity in the way presurgical data arc analyzed, most notably for functional neuroimaging. Visual analysis is much less reproducible

for such data than it is for structural MRI, whereas more objective assessments, using regions of interest (ROIs) or statistical parametric mapping (SPM), are highly sensitive to Inhibitors,research,lifescience,medical a number of parameters that largely varied among centers. Though we fully endorse the conclusions of the NHS R&D HTA program regarding the need of an appropriate assessment of presurgical investigations,

we feel that such an effort is unlikely to be developed for the majority of available techniques in the near future. Thus, we still need to Inhibitors,research,lifescience,medical primarily rely on our judgment to define the strategy of an optimal presurgical evaluation. Positron emission tomography (PET) The most commonly used tracer is 18F-fluorodcoxyglucose (FDG) whose brain accumulation reflects the local Inhibitors,research,lifescience,medical cerebral metabolic rate of glucose. Many studies have shown that in the interictal period, decreased glucose metabolism is usually observed within the lobe of seizure onset. Furthermore, comparisons between FDG-PET and invasive EEG

data have demonstrated that the hypometabolic areas often overlap with the region of ictal onset.55-57 However, areas of hypomctabolism are often larger than the epileptogenic Inhibitors,research,lifescience,medical zone, and might not necessarily predominate over the latter.58 Whether the extent of hypomctabolism Inhibitors,research,lifescience,medical outside the temporal lobe represents a risk factor for postoperative seizure recurrence after anterior temporal lobectomy is a matter of debate.59-61 The above issues account for the lack of consensual practical guidelines regarding the clinical, indications of FDG-PET in the presurgical evaluation of patients with drug-resistant epilepsy.54,62-64 There is, however, some consensus that the lack of detectable interictal hypomctabolism in patients contemplating Cilengitide temporal lobe surgery is associated with a poor seizure outcome.65-67 This finding might be particularly relevant in TLE patients with a normal MRI. Indeed, excellent, seizure outcome was reported in that, population, provided FDG-PET abnormalities were present.45 More generally, FDG-PET in patients with a seemingly normal MRI might, help to disclose subtle morphological abnormalities, including focal cortical dysplasia. Thus, despite the lack of official recommendation, it seems reasonable to offer FDG-PET, at least to surgical candidates whose MRI is normal.

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