PET in seizure disorders

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Interictal PET imaging

Interictal PET scanning has been used in a variety of seizure disorders for diagnostic and research purposes. The most commonly studied disorders include temporal lobe epilepsy and frontal lobe seizures. For example, an interictal PET study [15] in patients with complex partial seizures compared cerebral glucose metabolism and blood flow with various clinical variables, such as duration of seizure disorder, age at seizure onset, frequency of complex partial seizures, history of secondary

Ictal PET imaging

Performing ictal PET studies is more logistically impractical primarily because of the relatively short half-life of positron-emitting isotopes, such as [18F] [74]. Several ictal PET studies have been reported, however, which have been successful in the determination of seizure foci in patients with partial seizures. In these studies, the seizure focus appears as a hypermetabolic area. In earlier studies, Chugani et al [75] have devised a classification system to describe the metabolic patterns

Surgical planning with PET

Several studies have used PET imaging for the purpose of planning surgical interventions. Duncan et al [77] used [15O]-H2O PET in conjunction with anatomic images from MR imaging, which helped to determine the brain regions involved with motor activity, visual perception, articulation, and receptive language tasks in pediatric patients before temporal, and even extratemporal, surgery. At follow-up, the patients who underwent both temporal lobectomy and extratemporal resection for a neoplastic

Receptor PET imaging

PET imaging to measure various neurotransmitter systems has been used to study patients with seizures. Initial studies of benzodiazepine receptor activity in temporal lobe epilepsy showed decreased benzodiazepine receptor activity in the medial temporal lobe [80]. This reduction in benzodiazepine receptor activity may correlate with the frequency of seizures [81]. A more recent study compared the results obtained from FDG with carbon-11–flumazenil ([11C]-FMZ) [82]. FDG-PET images showed a large

Other seizure disorders

There are many other types of seizure disorders that have been investigated using PET imaging. Absence seizures are a common form of epilepsy associated with brief spells of loss of consciousness and is associated with 3-Hz generalized spike-wave activity on EEG. The actual site of the seizure origin, however, has been difficult to detect and localize. An [15O]-H2O PET cerebral blood flow study was performed on eight patients with idiopathic generalized epilepsy in whom typical absence seizures

Summary

PET imaging has been widely used in the evaluation and management of patients with seizure disorders. The ability of PET to measure cerebral function is ideal for studying the neurophysiologic correlates of seizure activity during both ictal and interictal states. PET imaging is also valuable for evaluating patients before surgical interventions to determine the best surgical method and maximize outcomes. PET will continue to play a major role, not only in the clinical arena, but also in

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References (108)

  • H.T. Chugani

    The use of positron emission tomography in the clinical assessment of epilepsy

    Semin Nucl Med

    (1992)
  • R. Korinthenberg et al.

    18FDG-PET in epilepsies of infantile onset with pharmacoresistant generalized tonic-clonic seizures

    Epilepsy Res

    (2004)
  • J.S. Duncan

    Imaging and epilepsy

    Brain

    (1997)
  • W.H. Theodore et al.

    Positron emission tomography in generalized seizures

    Neurology

    (1985)
  • B.W. Abou-Khalil et al.

    Positron emission tomography studies of cerebral glucose metabolism in chronic partial epilepsy

    Ann Neurol

    (1987)
  • J. Engel et al.

    Pathologic findings underlying focal temporal lobe hypometabolism in partial epilepsy

    Ann Neurol

    (1982)
  • J. Engel et al.

    Comparative localization of the epileptic foci in partial epilepsy by PET and EEG

    Ann Neurol

    (1982)
  • J. Engel et al.

    Local cerebral metabolism during partial seizures

    Neurology

    (1983)
  • W.H. Theodore et al.

    The role of positron emission tomography in the evaluation of seizure disorders

    Ann Neurol

    (1984)
  • W.H. Theodore et al.

    18F fluorodeoxyglucose positron emission tomography in refractory complex partial seizures [abstract]

    Ann Neurol

    (1983)
  • J. Engel

    PET scanning inpartial epilepsy

    Can J Neurol Sci

    (1991)
  • R. Duncan

    Epilepsy, cerebral blood flow, and cerebral metabolic rate

    Cerebrovasc Brain Metab Rev

    (1992)
  • W.H. Theodore et al.

    Complex partial seizures: cerebral structure and cerebral function

    Epilepsia

    (1986)
  • W.H. Theodore et al.

    FDG-positron emission tomography and invasive EEG: seizure focus detection and surgical outcome

    Epilepsia

    (1997)
  • R.M. Debets et al.

    Quantitative analysis of 18/FDG-PET in the presurgical evaluation of patients suffering from refractory partial epilepsy: comparison with CT, MRI, and combined subdural and depth EEG

    Acta Neurochir Suppl (Wien)

    (1990)
  • J.I. Breier et al.

    Effects of duration of epilepsy on the uncoupling of metabolism and blood flow in complex partial seizures

    Neurology

    (1997)
  • P. Matheja et al.

    Drug-induced changes in cerebral glucose consumption in bifrontal epilepsy

    Epilepsia

    (2000)
  • M.V. Spanaki et al.

    Relationship of seizure frequency to hippocampus volume and metabolism in temporal lobe epilepsy

    Epilepsia

    (2000)
  • I. Savic et al.

    Pattern of interictal hypometabolism in PET scans with fludeoxyglucose F 18 reflects prior seizure types in patients with mesial temporal lobe seizures

    Arch Neurol

    (1997)
  • S.F. Barrington et al.

    Clinical value of “ictal” FDG-positron emission tomography and the routine use of simultaneous scalp EEG studies in patients with intractable partial epilepsies

    Epilepsia

    (1998)
  • M. Koutroumanidis et al.

    Interictal regional slow activity in temporal lobe epilepsy correlates with lateral temporal hypometabolism as imaged with 18FDG PET: neurophysiological and metabolic implications

    J Neurol Neurosurg Psychiatry

    (1998)
  • H. Utsubo et al.

    Neuroimaging for investigation of seizures in children

    Pediatr Neurosurg

    (1992)
  • C.M. Verity et al.

    Long-term follow-up after cerebral hemispherectomy: neurophysiologic, radiologic, and psychological findings

    Neurology

    (1982)
  • C. Juhasz et al.

    Is epileptogenic cortex truly hypometabolic on interictal positron emission tomography?

    Ann Neurol

    (2000)
  • J. Engel et al.

    Patterns of human local cerebral glucose metabolism during epileptic seizures

    Science

    (1982)
  • O.N. Markand et al.

    Comparative study of interictal PET and ictal SPECT in complex partial seizures

    Acta Neurol Scand

    (1997)
  • J. Engel et al.

    Patterns of ictal and interictal local cerebral metabolic rate studies in man with positron computed tomography

  • W.H. Theodore et al.

    Neuroimaging in refractory partial seizures. comparison of PET, CT, and MRI

    Neurology

    (1986)
  • W.H. Theodore et al.

    Patterns of cerebral glucose metabolism in patients with partial seizures

    Neurology

    (1988)
  • D.E. Kuhl et al.

    Epileptic pattern of local cerebral metabolism and perfusion in human determined by emission computed tomography of 18FDG and 13NH3

    Ann Neurol

    (1979)
  • V. Salanova et al.

    Comparison of the intracarotid amobarbital procedure and interictal cerebral 18-fluorodeoxyglucose positron emission tomography scans in refractory temporal lobe epilepsy

    Epilepsia

    (1992)
  • S. Bernardi et al.

    An interictal study of partial epilepsy using positron emission tomography and oxygen 15 inhalation method

    J Neurol Neurosurg Psychiatry

    (1983)
  • G. Franck et al.

    Contribution of positron emission tomography to the investigation of epilepsies of frontal lobe origin

    Adv Neurol

    (1992)
  • R.F. Och et al.

    Correlations between the positron emission tomography measurement of glucose metabolism and oxygen utilization in focal epilepsy

    Neurology

    (1984)
  • Y.L. Yamamoto et al.

    Pattern of rCBF and focal energy metabolism in relation to electroencephalographic abnormality in the interictal phase of partial epilepsy

  • V. Salanova et al.

    FDG-PET and MRI in temporal lobe epilepsy: relationship to febrile seizures, hippocampal sclerosis and outcome

    Acta Neurol Scand

    (1998)
  • R.C. Knowlton et al.

    Presurgical multimodality neuroimaging in electroencephalographic lateralized temporal lobe epilepsy

    Ann Neurol

    (1997)
  • M. Sperling et al.

    Magnetic resonance imaging in intractable partial epilepsy: correlative studies

    Ann Neurol

    (1986)
  • L. Nagarajan et al.

    Contralateral temporal hypometabolism on positron emission tomography in temporal lobe epilepsy

    Acta Neurol Scand

    (1996)
  • C.Y. Wong et al.

    Outcome of temporal lobe epilepsy surgery predicted by statistical parametric PET imaging

    J Nucl Med

    (1996)

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