Grey and white matter flumazenil binding in neocortical epilepsy with normal MRI. A PET study of 44 patients

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DOI

  • Alexander Hammers, Hammersmith Hospital, National Society for Epilepsy, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London
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  • Matthias J. Koepp, Hammersmith Hospital, National Society for Epilepsy, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London
  • ,
  • Mark P. Richardson, Hammersmith Hospital, National Society for Epilepsy, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London
  • ,
  • René Hurlemann, National Society for Epilepsy, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London
  • ,
  • David J. Brooks
  • John S. Duncan, National Society for Epilepsy, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London

In 20-30% of potential surgical candidates with refractory focal epilepsy, standard MRI does not identify the cause. γ-Aminobutyric acid (GABA) is the principal inhibitory neurotransmitter in the brain. [11C]Flumazenil (FMZ) PET images most subtypes of GABAA receptors, present on most neurons. We investigated [11C]FMZ binding in grey and white matter in 16 normal controls and in 44 patients with refractory neocortical focal epilepsy and normal optimal MRI. Fourteen patients had unilateral frontal lobe epilepsy, five occipital lobe epilepsy (OLE), six parietal lobe epilepsy (PLE) and 19 neocortical epilepsy that was not clearly lobar. Parametric images of FMZ volume of distribution (FMZ-Vd) were computed. Statistical parametric mapping (SPM99) with explicit masking, including the white matter, was used to analyse individual patients and groups. Thirty-three of the 44 patients showed focal abnormal FMZ-Vd; increases in 16, decreases in eight, and both increases and decreases in nine. In seven patients, the increases in FMZ binding were periventricular, in locations normally seen in periventricular nodular heterotopia on MRI. There were frontal and parietal increases in FMZ binding in grey and white matter in the PLE group and decreases in the cingulate gyrus in the OLE group. FMZ binding increases, particularly periventricular increases, were a prominent feature of MRI-negative focal epilepsies and may represent neuronal migration disturbances.

Original languageEnglish
JournalBrain
Volume126
Issue6
Pages (from-to)1300-1318
Number of pages19
ISSN0006-8950
DOIs
Publication statusPublished - 1 Jun 2003
Externally publishedYes

    Research areas

  • Frontal lobe epilepsy, Localization-related epilepsy, Occipital lobe epilepsy, Parietal lobe epilepsy, SPM99

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