title: Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy.
abstract: OBJECTIVE
  To compare abnormalities determined in 2-deoxy-2-[18F]fluoro-D-glucose (FDG) and [11C]flumazenil (FMZ) PET images with intracranial EEG data in patients with extratemporal lobe epilepsy.
  
  
  BACKGROUND
  Although PET studies with FDG and FMZ are being used clinically to localize epileptogenic regions in patients with refractory epilepsy, the electrophysiologic significance of the identified PET abnormalities remains poorly understood.
  
  
  METHODS
  We studied 10 patients, mostly children (4 boys, 6 girls, aged 2 to 19 years; mean age, 11 years), who underwent FDG and FMZ PET scans, intracranial EEG monitoring, and cortical resection for intractable epilepsy. EEG electrode positions relative to the brain surface were determined from MRI image volumes. Cortical areas of abnormal glucose metabolism or FMZ binding were determined objectively based on asymmetry measures derived from homotopic cortical areas at three asymmetry thresholds. PET data were then coregistered with the MRI and overlaid on the MRI surface. A receiver operating characteristics (ROC) analysis was performed to determine the specificity and sensitivity of PET-defined abnormalities against the gold standard of intracranial EEG data.
  
  
  RESULTS
  FMZ PET detected at least part of the seizure onset zone in all subjects, whereas FDG PET failed to detect the seizure onset region in two of 10 patients. The area under the ROC curves was higher for FMZ than FDG PET for both seizure onset (p = 0.01) and frequent interictal spiking (p = 0.04). Both FMZ and FDG PET showed poor performance for detection of rapid seizure spread (area under the ROC curve not significantly different from 0.5).
  
  
  CONCLUSIONS
  [11C]flumazenil (FMZ) PET is significantly more sensitive than 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET for the detection of cortical regions of seizure onset and frequent spiking in patients with extratemporal lobe epilepsy, whereas both FDG and FMZ PET show low sensitivity in the detection of cortical areas of rapid seizure spread. The application of PET, in particular FMZ PET, in guiding subdural electrode placement in refractory extratemporal lobe epilepsy will enhance coverage of the epileptogenic zone.
authors.affiliation: Department of Radiology, Children's Hospital of Michigan and the Detroit Medical Center, Wayne State University School of Medicine, 48201, USA.
authors.forename: O
authors.initials: O
authors.lastname: Muzik
authors.forename: E A
authors.initials: EA
authors.lastname: da Silva
authors.forename: C
authors.initials: C
authors.lastname: Juhasz
authors.forename: D C
authors.initials: DC
authors.lastname: Chugani
authors.forename: J
authors.initials: J
authors.lastname: Shah
authors.forename: F
authors.initials: F
authors.lastname: Nagy
authors.forename: A
authors.initials: A
authors.lastname: Canady
authors.forename: H M
authors.initials: HM
authors.lastname: von Stockhausen
authors.forename: K
authors.initials: K
authors.lastname: Herholz
authors.forename: J
authors.initials: J
authors.lastname: Gates
authors.forename: M
authors.initials: M
authors.lastname: Frost
authors.forename: F
authors.initials: F
authors.lastname: Ritter
authors.forename: C
authors.initials: C
authors.lastname: Watson
authors.forename: H T
authors.initials: HT
authors.lastname: Chugani
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D001921:Brain / Q000378:metabolism / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D005442:Flumazenil; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed
chemical_list: D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18; D005442:Flumazenil