• Neus Mongay-Ochoa, Jacint Sala-Padró, Gabriel Reynés-Llompart, Laura Rodríguez-Bel, Sònia Jaraba, Francisco Morandeira, and Mercè Falip.
• Epilepsy Unit, Department of Neurology, Hospital Universitari de Bellvitge, Barcelona, Spain.
• J Neuroimaging. 2021 Sep 1; 31 (5): 869-873.

Background And PurposeGlutamic acid decarboxylase antibodies (GAD-Ab) are sometimes associated with chronic drug-resistant focal epilepsy. Clinically, it may manifest as mesial temporal lobe epilepsy (mTLE), with GAD-Ab patients difficult to distinguish. Therefore, the aim of this study is to compare brain metabolism of patients with mTLE and high serum titers of GAD-Ab (>2000 UI/ml) to those with mTLE and hippocampal sclerosis (HS) and confirmed GAD-ab negativity.MethodsImages from PET studies were normalized to an SPM 12 template. Voxel to voxel comparisons were made using a two-sample one-tailed t-test.ResultsIn both patients with GAD-Ab and controls (mTLE-HS), hypometabolism in mesial temporal lobe areas was observed. When comparing the two groups, GAD-Ab patients had statistically significant reduced metabolism in both insulae and medial inferior frontal-hypothalamus area (p < 0.001).ConclusionsHypometabolism in mesial temporal lobe areas together with hypometabolism in insulae and medial inferior frontal-hypothalamus may be characteristic of patients with epilepsy and GAD-ab. This PET pattern could be a useful diagnostic tool to identify GAD-Ab patients.© 2021 American Society of Neuroimaging.

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