title: Epilepsy surgery in a case of encephalitis: use of 11C-PK11195 positron emission tomography.
abstract: The positron emission tomography radiotracer (11)C-PK11195 selectively binds to the peripheral-type benzodiazepine receptors expressed in activated microglia and can, therefore, detect areas of neuroinflammation. (11)C-PK11195 positron emission tomography was used in determining the surgical treatment of a 5-year-old boy with intractable epilepsy due to encephalitis of unknown etiology. After 4 months of treatment in the pediatric intensive care unit for altered consciousness and refractory seizures despite multiple anticonvulsants, including continuous midazolam infusion, (11)C-PK11195 positron emission tomography revealed an area of increased uptake in the left temporal-occipital cortex. Because the majority of his seizures at this stage of his illness emanated from the same region, the patient underwent left temporal-occipital cortical resection guided by intraoperative electrocorticography. The surgery resulted in significant recovery, and he could be discharged from the hospital. Focal areas of neuroinflammation may play an important role in seizure pathogenesis in a subset of patients with refractory seizures associated with encephalitis. In such cases, (11)C-PK11195 positron emission tomography may highlight the region of maximal inflammation for palliative surgical treatment.
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.forename: Harry T
authors.initials: HT
authors.lastname: Chugani
authors.forename: Aimee
authors.initials: A
authors.lastname: Luat
authors.forename: Eishi
authors.initials: E
authors.lastname: Asano
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sood
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D002675:Child, Preschool; D004351:Drug Resistance; D004660:Encephalitis / Q000150:complications / Q000175:diagnosis; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006423:Hemianopsia / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007150:Immunohistochemistry; D007546:Isoquinolines; D008297:Male; D019635:Neurosurgical Procedures; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000503:physiopathology; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D007546:Isoquinolines; D019275:Radiopharmaceuticals; C037850:PK 11195