Abstracts

Hippocampal sclerosis (HS) must be an important prognostic factor in terms of medical treatment and also resectable epilepsy surgery. Decreased glucose metabolism in epileptogenic focus was suggestive of irreversible damage with prognostic implication. Attention has not been much paid to the prognostic implication between the glucose metabolism in temporal lobe and HS.We tried to define the clinical characteristics in temporal lobe epilepsy (TLE) depending on the decrease of the glucose metabolism and also the impact of hippocampal sclerosis in the same situation. 68 epilepsy patients with temporal spike in EEG were recruited. 56 patients among them had unilateral hippocampal sclerosis in MRI. The patients with additional lesion except for HS in MRI were excluded and patient with history of central nervous infection also excluded even in case of the isolated unilateral HS in MRI. Analysis was done to define the clinical profiles and prognosis between 40 patients with HS and 11 patients without HS. All of those showied decreased glucose metabolism in temporal lobe in ¹⁸F-FDG PET image. Another trial was done between those 56 patients with decreased metabolism in temporal lobe and 12 patients with normal MRI but without decrease of glucose metabolism in PET. In the first trial, preponderance of female prevalence was noted, even in group of normal MRI with decreased metabolism. The incidence of head trauma in addition to the febrile convulsion was statistically significant higher in the group with HS (P[lt]0.05). Automatism was in higher in HS group but nocturnal preponderance was noted in normal MRI group. Good prognosis (Angel[apos] class I. and II.) was statistically significant in normal MRI group (17.5 % vs. 43.8 %; P[lt]0.05). In second trial, head trauma was also higher incidence in the group with normal glucose metabolism than those of the decreased glucose metabolism. Complex partial seizure without 2[apos] GTC, clustering nature, and nocturnal dominancy were statistically significant higher in normal glucose group. The prognosis of the group with normal metabolism was statistically significant (p[lt]0.05) better than those of the group with decreased glucose metabolism and normal MRI. This study suggested that decreased glucose metabolism in temporal lobe made some effect on difference of clinical profiles of TLE, even though in the presence of HS. Decreased glucose metabolism in TLE seemed to be an independent prognostic factor irrespective of the presence of HS in MRI.