Imaging Inflammation in a Patient with Epilepsy Due to Focal Cortical Dysplasia

Tracy Butler*, Masanori Ichise, Andrew F. Teich, Elizabeth Gerard, Joseph Osborne, Jacqueline French, Orrin Devinsky, Ruben Kuzniecky, Frank Gilliam, Fahad Pervez, Frank Provenzano, Stanley Goldsmith, Shankar Vallabhajosula, Emily Stern, David Silbersweig

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

background and purpose: Evidence from animal models and examination of human epilepsy surgery specimens indicates that inflammation plays an important role in epilepsy. Positron emission tomography (PET) using [C11]PK11195, a marker of activated microglia, provides a means to visualize neuroinflammation in vivo in humans. We hypothesize that in patients with active epilepsy, [C11]PK11195 PET (PK-PET) may be able to identify areas of focally increased inflammation corresponding to the seizure onset zone. Methods: A young woman with intractable epilepsy underwent PK-PET as part of an approved research study. PK-PET results were compared with results from other clinical studies. Results: PK-PET revealed an area of focally increased radiotracer uptake in the right frontal lobe corresponding to this patient's seizure focus as identified by ictal and interictal 18F-fluorodeoxyglucose (FDG)-PET and EEG. Routine brain magnetic resonance imaging (MRI) was initially considered normal, though high-resolution studies showed possible subtle dysplasia of the right frontal lobe. The patient underwent a right frontal lobe resection, and pathological evaluation showed focal cortical dysplasia with activated microglia. Conclusions: PK-PET can identify neuroinflammation associated with subtle focal cortical dysplasia, and may therefore have a clinical role in guiding epilepsy surgery for patients with difficult-to-localize seizure foci.

Original languageEnglish (US)
Pages (from-to)129-131
Number of pages3
JournalJournal of Neuroimaging
Volume23
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Epilepsy
  • Focal cortical dysplasia
  • Inflammation
  • Microglia
  • Pk11195
  • Positron emission tomography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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