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PET in Epilepsy

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PET and SPECT in Neurology

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Abstract

The major drawback in clinical PET imaging is that of specificity: in epilepsy, PET shows both the cause and consequence of seizure activity in the focus and projection area of the seizure onset. This can make treatment decisions for resective surgery difficult.

[18F]FDG PET has been long integrated in presurgical neuroimaging in many centres and proved to be clinically useful in identifying focal glucose metabolic abnormalities.

[1lC]Flumazenil, which delineates γ-aminobutyric acid receptor A (GABA-A) availability, may provide a biochemical marker of epileptogenicity and strengthens the hypothesis that inhibitory mechanisms are disturbed in the epileptic focus. Although [1lC]flumazenil, and other novel PET ligands for opioid and serotonin neurotransmission, showed great potential in selected patient subgroups, these tracers have not yet reached the stage of routine clinical application.

Ultimately, the challenge for PET imaging in epilepsy, like for most CNS diseases, is overcoming drug-resistance due to poor delivery and/or retention of pharmaceuticals across the blood-brain barrier. There is the potential of PET to be relevant for the selection of certain novel treatment strategies, beyond the localisation of the focus for resective surgery.

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Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK

    Matthias Koepp MD, PhD & Maria Feldmann

Authors
  1. Matthias Koepp MD, PhD
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  2. Maria Feldmann
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Corresponding author

Correspondence to Matthias Koepp MD, PhD .

Editor information

Editors and Affiliations

  1. Dept. of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    Rudi A.J.O. Dierckx

  2. Faculty of Electrical Engineering and Information Technology, University of Applied Sciences Offenburg, Offenburg, Germany

    Andreas Otte

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Erik F.J. de Vries

  4. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Aren van Waarde

  5. Neurology, University Medical Center Groningen, Groningen, The Netherlands

    Klaus L. Leenders

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Koepp, M., Feldmann, M. (2014). PET in Epilepsy. In: Dierckx, R., Otte, A., de Vries, E., van Waarde, A., Leenders, K. (eds) PET and SPECT in Neurology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54307-4_38

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  • DOI: https://doi.org/10.1007/978-3-642-54307-4_38

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  • Online ISBN: 978-3-642-54307-4

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