Hammers Alexander, Koepp Matthias J, Brooks David J, Duncan John S
MRC Clinical Sciences Centre and Division of Neuroscience, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Epilepsia. 2005 Jun;46(6):944-8. doi: 10.1111/j.1528-1167.2005.30904.x.
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.
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-Vd. Statistical parametric mapping (SPM99) with explicit masking was used to investigate the entire brain volume including WM.
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.
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.
在海马硬化（HS）患者中，颞叶前部切除术使三分之二的患者有可能长期抑制癫痫发作。白质（WM）[11C]氟马西尼分布容积（FMZ-Vd）反映了WM中神经元细胞体的数量。我们的目的是将单侧HS患者的WM FMZ-Vd与术后结果进行关联。
我们对15例难治性内侧颞叶癫痫（mTLE）患者进行了[11C]FMZ-PET检查，并对所有病例进行了定量MRI诊断为单侧HS，随后进行了组织学验证。中位随访时间为7年（范围6 - 9年）。使用代谢物校正的动脉血浆输入函数和频谱分析来生成[11C]FMZ-Vd的参数图像。使用带有显式掩蔽的统计参数映射（SPM99）来研究包括WM在内的全脑体积。
8例患者达到Engel IA级结果（术后完全无癫痫发作），7例未达到无癫痫发作。将无癫痫发作的患者与术后仍有癫痫发作的患者进行比较，发现预后欠佳的患者在同侧（z = 3.7）和对侧（z = 2.7）脑室后角周围的FMZ结合增加。
术前[11C]FMZ-PET可以检测mTLE患者脑室周围WM FMZ结合增加，这意味着WM中存在异位神经元。这种增加的存在与较差的预后相关。
