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Surgeon General Reports, SAMHSA TIPs, SAMHSA PEPs AHCPR Archived Technology Assessments 18F-Labeled 2-Deoxy-2-fluoro-D-glucose Positron-Emission Tomography Scans for the Localization of the Epileptogenic Foci Prepared by: S. Steven Hotta, M.D., Ph.D. Health Technology Assessment: Number 12 U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research Rockville, Maryland July 1998 AHCPR Pub. No. 98-0044 View the Medline Citation and Related Citations using PubMed AbstractThe localization of epileptogenic foci that are amenable to curative epilepsy surgery may be accomplished by noninvasive surface electroencephalogram (EEG) recordings, clinical observations, computed tomography (CT), magnetic resonance imaging (MRI), and neuropsychologic tests. Other tests, such as invasive EEG, 18F-fluoro-deoxyglucose-positron-emission tomography (FDG-PET or PET) scans, and single-photon-emission computed tomography (SPECT) scans, have also been used at various epilepsy centers to help identify candidates who might benefit from such surgery. Interictal PET scans have demonstrated hypometabolism in areas concordant with the epileptogenic foci indicated by other diagnostic tests such as EEG and MRI. However, PET scans have also shown no abnormality in many patients with EEG-indicated epileptogenic foci; in others, the scans have shown abnormal metabolism in areas that were discordant with the epileptogenic foci. Although substitution of the noninvasive PET scan for the invasive EEG recordings would be desirable, the available data were insufficient to determine whether PET scans might serve as a reliable substitute for EEG. A positive PET scan might contribute independent information for identifying the epileptogenic site but could be noncontributory or confusing when hypometabolism is not seen or is seen in presumably normal brain areas. It is not evident from the data in the literature to what extent confirmatory PET scan findings might contribute to the management of patients with complex partial seizures. ForewordThe Center for Practice and Technology Assessment (CPTA) evaluates the risks, benefits, and clinical effectiveness of new or established medical technologies. In most instances, assessments address technologies that are being reviewed for purposes of coverage by federally funded health programs. The CPTA assessment process includes a comprehensive review of the medical literature and emphasizes broad and open participation from within and outside the Federal Government. A range of expert advice is obtained by widely publicizing the plans for conducting the assessment through publication of an announcement in the Federal Register and solicitation of input from Federal agencies, medical specialty societies, insurers, and manufacturers. The involvement of these experts helps ensure inclusion of the experienced and varying viewpoints needed to round out the data derived from individual scientific studies in the medical literature. The CPTA analyzed and synthesized data and information received from experts and the scientific literature. The results are reported in this assessment. Each assessment represents a detailed analysis of the risks, clinical effectiveness, and uses of new or unestablished medical technologies. If an assessment has been prepared to form the basis for a coverage decision by a federally financed health care program, it serves as the Public Health Service's recommendation to that program and is disseminated widely. The CPTA is one component of the Agency for Health Care Policy and Research (AHCPR), Public Health Service, Department of Health and Human Services. Douglas B. Kamerow, M.D., M.P.H., Director, Center for Practice and Technology Assessment
Acc:: Accuracy ART:: Arrhythmia research technology BBB:: Bundle branch block CAD:: Coronary artery disease CAST:: Cardiac arrhythmia suppression trials CFR:: Case fatality rate CHF:: Congestive heart failure CI:: Confidence interval CT:: Computed tomography dQRS:: Duration of the filtered QRS complex > 106 ms ECG:: Electrocardiogram EEG:: Electroencephalogram/electroencephalography FD:: Frequency domain FDA:: Food and Drug Administration FDG-PET:: Fluorodeoxyglucose-positron-emission tomography FU:: Followup HCFA:: Health Care Financing Administration IDC:: Idiopathic dilated cardiomyopathy i-EEG:: Invasive electroencephalography LAS:: Low amplitude signal LVEF:: Left ventricular ejection fraction LVH:: Left ventricular hypertrophy MeSH:: Medical subject heading MI:: Myocardial infarction MRI:: Magnetic resonance imaging MUGA:: Multigated acquisition NPV:: Negative predictive value NS:: Not stated NSR:: Normal sinus rhythm NYHA:: New York Heart Association PES:: Programmed electrical stimulation PET:: Positron-emission tomography PPV:: Positive predictive value RMS:: Root mean square voltage during the last 40 ms of the QRS complex <25 µV RNV:: Radionuclide ventriculography SAEGG:: Signal-averaged electrocardiography SD:: Sudden death 1SD:: One standard deviation Se:: Sensitivity s-EEG:: Surface/sphenoidal electroencephalography Sp:: Specificity SPECT:: Single-photon-emission computed tomography STA:: Spectral turbulence analysis TD:: Time domain VAT:: Ventricular activation time VF:: Ventricular fibrillation VLP:: Ventricular late potentials |