Hammers Alexander, Koepp Matthias J, Richardson Mark P, Hurlemann René, Brooks David J, Duncan John S
MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Brain. 2003 Jun;126(Pt 6):1300-18. doi: 10.1093/brain/awg138.
In 20-30% of potential surgical candidates with refractory focal epilepsy, standard MRI does not identify the cause. gamma-Aminobutyric acid (GABA) is the principal inhibitory neurotransmitter in the brain. [(11)C]Flumazenil (FMZ) PET images most subtypes of GABA(A) receptors, present on most neurons. We investigated [(11)C]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-V(d)) 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-V(d); 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.
在20% - 30%患有难治性局灶性癫痫的潜在手术候选者中，标准磁共振成像（MRI）无法确定病因。γ-氨基丁酸（GABA）是大脑中的主要抑制性神经递质。[（11）C]氟马西尼（FMZ）正电子发射断层扫描（PET）可成像大多数神经元上存在的大多数GABA（A）受体亚型。我们研究了16名正常对照者以及44名患有难治性新皮质局灶性癫痫且MRI结果正常的患者的灰质和白质中[（11）C]FMZ的结合情况。14名患者患有单侧额叶癫痫，5名患有枕叶癫痫（OLE），6名患有顶叶癫痫（PLE），19名患有未明确叶性的新皮质癫痫。计算了FMZ分布容积（FMZ-V(d)）的参数图像。使用具有明确掩蔽（包括白质）的统计参数映射（SPM99）来分析个体患者和组。44名患者中有33名显示出局灶性FMZ-V(d)异常；16名增加，8名减少，9名既有增加又有减少。在7名患者中，FMZ结合增加位于脑室周围，这是MRI上脑室周围结节性异位症常见的位置。PLE组的灰质和白质中FMZ结合在额叶和顶叶增加，OLE组的扣带回减少。FMZ结合增加，尤其是脑室周围增加，是MRI阴性局灶性癫痫的一个突出特征，可能代表神经元迁移障碍。
