Savic I, Thorell J O, Roland P
Department of Neuroscience, Karolinska Institute, Stockholm, Sweden.
Epilepsia. 1995 Dec;36(12):1225-32. doi: 10.1111/j.1528-1157.1995.tb01066.x.
Presently available noninvasive methods correctly localize epileptogenic regions in only approximately 50% of patients with frontal lobe epilepsy (FLE). Earlier studies have shown that temporal lobe epileptogenic regions may be identified readily by positron emission tomography (PET) measurements of regional benzodiazepine (BZD) receptor binding. We tested the specific applicability of this method in patients with FLE. Six patients with frontal partial seizures and 7 healthy men were investigated with PET and the BZD receptor ligand [11C]flumazenil. All patients had magnetic resonance (MR) brain scans. The independent assessment of seizure-onset region was based on seizure semiology, intra- and extracranial EEG and, in 4 cases, also on [18F]fluorodeoxyglucose (FDG)-PET. The epileptic focus/seizure-generating region was correctly identified by [11C]flumazenil PET in all patients. This region was characterized by a significant reduction in BZD receptor density. The area with reduced BZD receptor density was better delimited than the corresponding hypometabolic region, which was observed in 50% of patients investigated with [18F]FDG-PET. MRI was normal in 5 patients. Visualization of BZD receptors with [11C]flumazenil PET appears to be a promising approach for noninvasive identification of frontal lobe epileptogenic regions.
目前可用的非侵入性方法仅能在约50%的额叶癫痫（FLE）患者中正确定位致痫区域。早期研究表明，通过正电子发射断层扫描（PET）测量区域苯二氮䓬（BZD）受体结合情况，可以很容易地识别颞叶致痫区域。我们测试了该方法在FLE患者中的具体适用性。对6例额叶部分性癫痫患者和7名健康男性进行了PET和BZD受体配体[11C]氟马西尼检查。所有患者均进行了脑部磁共振（MR）扫描。发作起始区域的独立评估基于发作症状学、颅内和颅外脑电图，在4例患者中还基于[18F]氟脱氧葡萄糖（FDG）-PET。所有患者均通过[11C]氟马西尼PET正确识别了癫痫病灶/发作产生区域。该区域的特征是BZD受体密度显著降低。BZD受体密度降低的区域比相应的代谢减低区域界定得更好，在接受[18F]FDG-PET检查的50%患者中观察到了代谢减低区域。5例患者的MRI结果正常。用[11C]氟马西尼PET可视化BZD受体似乎是一种用于非侵入性识别额叶致痫区域的有前景的方法。
