제1저자 Rita Yu(한림대)
교신저자 박해정(핵의학교실, BK21), 이준수(소아과학교실)
Epilepsia. 2018 Oct 28. doi: 10.1111/epi.14590. [Epub ahead of print]
Interregional metabolic connectivity of 2-deoxy-2[18 F]fluoro-D-glucose positron emission tomography in vagus nerve stimulation for pediatric patients with epilepsy: A retrospective cross-sectional study.
Yu R1, Park HJ2,3, Cho H2, Ko A4, Pae C2,3, Oh MK2, Kang HC5, Kim HD5, Park EK6, Shim KW6, Kim DS6, Lee JS5.
1Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.2Departments of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea.3BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea.4Department of Pediatrics, Pusan National University Children''s Hospital, Pusan National University College of Medicine, Yangsan, Korea.5Division of Pediatric Neurology, Severance Children''s Hospital, Yonsei University College of Medicine, Seoul, Korea.6Department of Pediatric Neurosurgery, Severance Children''s Hospital, Yonsei University College of Medicine, Seoul, Korea.
With the recognition of epilepsy as a network disease that disrupts the organizing ability of resting-state brain networks, vagus nerve stimulation (VNS) may control epileptic seizures through modulation of functional connectivity. We evaluated preoperative 2-deoxy-2[18 F]fluoro-D-glucose (FDG) positron emission tomography (PET) in VNS-implanted pediatric patients with refractory epilepsy to analyze the metabolic connectivity of patients and its prognostic role in seizure control.
Preoperative PET data of 66 VNS pediatric patients who were followed up for a minimum of 1 year after the procedure were collected for the study. Retrospective review of the patients'' charts was performed, and five patients with inappropriate PET data or major health issues were excluded. We conducted an independent component analysis of FDG-PET to extract spatial metabolic components and their activities, which were used to perform cross-sectional metabolic network analysis. We divided the patients into VNS-effective and VNS-ineffective groups (VNS-effective group, ≥50% seizure reduction; VNS-ineffective group, <50% reduction) and compared metabolic connectivity differences between groups using a permutation test.
Thirty-four (55.7%) patients showed >50% seizure reduction from baseline frequency 1 year after VNS. A significant difference in metabolic connectivity evaluated by preoperative FDG-PET was noted between groups. Relative changes in glucose metabolism were strongly connected among the areas of brainstem, cingulate gyrus, cerebellum, bilateral insula, and putamen in patients with <50% seizure control after VNS.
This study shows that seizure outcome of VNS may be influenced by metabolic connectivity, which can be obtained from preoperative PET imaging. This study of metabolic connectivity analysis may contribute in further understanding of the mechanism of VNS in intractable seizures.