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Basic Science Investigations |
1 Commissariat à l’Energie Atomique, Direction des Sciences du Vivant, Département de Recherche Médicale, Service Hospitalier Frédéric Joliot, Orsay, France
2 Unité de Neurophysiologie et d’Epileptologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
3 Service de Neurologie, CHU Pontchaillou, Rennes, France
4 Service de Neurochirurgie, Hôpital Saint Anne, Paris, France
Studies in animal models and epileptic patients have led to the suggestion that the basal ganglia (BG) are involved in seizures. PET with 6-18F-L-3,4-fluorodihydroxyphenylalanine (18F-fluoro-L-DOPA) has recently demonstrated a reduction of striatal dopamine uptake in drug-resistant epileptic patients with ring chromosome 20 (r20) using a multiple-time graphical analysis. The aim of the present study was to evaluate the involvement of dopamine in other epileptic syndromes using a multiple-time graphical analysis and the all-brain statistical parametric mapping (SPM) analysis. Methods: Patients with drug-resistant epilepsy were divided into 3 groups: group 1, with r20 epilepsy (n = 16; mean age ± SD, 21.5 ± 5.4 y); group 2, with resistant generalized "absence-like" epilepsy (n = 10; mean age, 32.3 ± 11.4 y); and group 3, with drug-resistant temporal lobe epilepsy with hippocampal sclerosis (n = 9; mean age, 35.2 ± 10.3 y). We compared 2 strategies of analysis of the 18F-fluoro-L-DOPA uptake constant (Ki, min–1) in BG using a multiple-time graphical analysis using regions of interest (the gold-standard method) and an SPM analysis using a voxel-by-voxel statistical t test to avoid a priori hypotheses in the analysis. Each epileptic group was compared with a group of healthy volunteers (n = 10; mean age, 45.1 ± 16.5 y). Results: A decrease of the mean Ki value was observed in the striatum in all groups of patients with both types of analysis. With multiple-time graphical analysis, the reduction was evident using the averaged Ki values over both hemispheres in each BG. Unilateral decreases in each BG were detected in SPM analysis. A ratio of decrease of 18F-fluoro-L-DOPA uptake was observed in the 3 groups of patients. Only the SPM analysis showed a decrease of 18F-fluoro-L-DOPA uptake ipsilateral to the seizure side in patients with temporal lobe epilepsy. Moreover, the all-brain SPM analysis showed a decrease of 18F-fluoro-L-DOPA uptake in the substantia nigra bilaterally (P < 0.001). Conclusion: This result confirms the involvement of dopamine neurotransmission in seizure control related to the type of epileptic syndrome. The difference in epileptic types may depend in part on the seizure frequency.
Key Words: epileptic syndromes • basal ganglia • PET • 18F-fluoro-L-DOPA
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