Periventricular white matter flumazenil binding and postoperative outcome in hippocampal sclerosis

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

Purpose: In patients with hippocampal sclerosis (HS), anterior temporal lobe resection offers the possibility of a long-lasting suppression of seizures in two thirds of patients. White matter (WM) [11C]flumazenil volume of distribution (FMZ-Vd) reflects the number of neuronal cell bodies in WM. Our objective was to correlate WM FMZ-Vd in patients with unilateral HS and postsurgical outcome. Methods: We performed [ 11C]FMZ-PET in 15 patients with refractory mesial temporal lobe epilepsy (mTLE) and a quantitative MRI diagnosis of unilateral HS subsequently histologically verified in all cases. Median follow-up was 7 years (range, 6-9 years). Metabolite-corrected arterial plasma input functions and spectral analysis were used to generate parametric images of [11C]FMZ-V d. Statistical parametric mapping (SPM99) with explicit masking was used to investigate the entire brain volume including WM. Results: Eight patients had Engel class IA outcome (completely seizure free since surgery), and seven were not seizure free. Comparison of seizure-free patients with those who continued to have seizures after surgery revealed areas of increased FMZ binding around the posterior horns of the ipsilateral (z = 3.7) and contralateral (z = 2.7) ventricles in those with suboptimal outcomes. Conclusions: Preoperative [11C]FMZ-PET can detect periventricular increases of WM FMZ binding, implying heterotopic neurons in WM, in patients with mTLE. The presence of such increases correlates with a poorer outcome.

Original languageEnglish
JournalEpilepsia
Volume46
Issue6
Pages (from-to)944-948
Number of pages5
ISSN0013-9580
DOIs
Publication statusPublished - 1 Jun 2005
Externally publishedYes

    Research areas

  • Epilepsy, PET, SPM99, Statistical parametric mapping, Temporal lobe epilepsy

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