C. Juhasz et al., Electroclinical correlates of flumazenil and fluorodeoxyglucose PET abnormalities in lesional epilepsy, NEUROLOGY, 55(6), 2000, pp. 825-834
Objective: To analyze the clinical utility of [C-11]flumazenil (FMZ) PET to
detect perilesional and remote cortical areas of abnormal benzodiazepine r
eceptor binding in relation to MRI, 2-deoxy-2-[F-18] fluoro-D-glucose (FDG)
PET, and electrocorticographic (ECoG) findings as well as clinical charact
eristics of the epilepsy in epileptic patients with brain lesion. Backgroun
d: The success of resective surgery in patients with medically intractable
epilepsy and brain lesion depends not only on removal of the lesion itself
but also on the reliable presurgical delineation of the epileptic cortex th
at commonly extends beyond it. PET could provide a noninvasive identificati
on of such epileptogenic areas. Methods: Seventeen patients underwent high
resolution MRI, FDG and FMZ PET, and presurgical EEG evaluation, including
chronic intracranial ECoG monitoring or intraoperative ECoG. Regional corti
cal FDG/FMZ PET abnormalities were defined on partial volume-corrected PET
images using an objective method based on a semiautomated definition of are
as with abnormal asymmetry. Structural lesions were defined on coregistered
MRI. The marked PET abnormalities visualized on three-dimensional cortical
surface were compared with each other, to the extent of MRI-defined lesion
, as well as to ECoG findings, Results: The mean surface extent of FMZ PET
abnormalities was significantly larger than the corresponding structural le
sions, but it was significantly smaller than areas of glucose hypometabolis
m. The size of perilesional FDG PET abnormalities showed a correlation with
the lifetime number of seizures (r = 0.93, p = 0.001). The extent of peril
esional FMZ PET abnormalities was independent of the seizure number and sho
wed an excellent correspondence with spiking cortex, the resection of which
resulted in seizure-free outcome in all but one operated patient. Remote F
MZ PET abnormalities (n = 6) were associated with early age at seizure onse
t (p = 0.048) and appeared in ipsilateral synaptically connected regions fr
om the lesion area. Conclusions: Three-dimensional surface-rendered FMZ PET
is able to delineate perilesional epileptic cortex, and it may be especial
ly useful to localize such areas in patients with extensive perilesional gl
ucose hypometabolism associated with a large number of seizures. Remote FMZ
PET abnormalities in patients with early onset and long duration of epilep
sy might represent secondary epileptogenesis, but this requires further stu
dy.