title: Imaging inflammation in a patient with epilepsy due to focal cortical dysplasia.
abstract: OBJECTIVE
  Evidence from animal models and examination of human epilepsy surgery specimens indicates that inflammation plays an important role in epilepsy. Positron emission tomography (PET) using [C11]PK11195, a marker of activated microglia, provides a means to visualize neuroinflammation in vivo in humans. We hypothesize that in patients with active epilepsy, [C11]PK11195 PET (PK-PET) may be able to identify areas of focally increased inflammation corresponding to the seizure onset zone.
  
  
  METHODS
  A young woman with intractable epilepsy underwent PK-PET as part of an approved research study. PK-PET results were compared with results from other clinical studies.
  
  
  RESULTS
  PK-PET revealed an area of focally increased radiotracer uptake in the right frontal lobe corresponding to this patient's seizure focus as identified by ictal and interictal 18F-fluorodeoxyglucose (FDG)-PET and EEG. Routine brain magnetic resonance imaging (MRI) was initially considered normal, though high-resolution studies showed possible subtle dysplasia of the right frontal lobe. The patient underwent a right frontal lobe resection, and pathological evaluation showed focal cortical dysplasia with activated microglia.
  
  
  CONCLUSIONS
  PK-PET can identify neuroinflammation associated with subtle focal cortical dysplasia, and may therefore have a clinical role in guiding epilepsy surgery for patients with difficult-to-localize seizure foci.
authors.affiliation: New York University Comprehensive Epilepsy Center, School of Medicine, New York University, NY 10016, USA. Tracy.Butler@nyumc.org
authors.forename: Tracy
authors.initials: T
authors.lastname: Butler
authors.forename: Masanori
authors.initials: M
authors.lastname: Ichise
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Teich
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gerard
authors.forename: Joseph
authors.initials: J
authors.lastname: Osborne
authors.forename: Jacqueline
authors.initials: J
authors.lastname: French
authors.forename: Orrin
authors.initials: O
authors.lastname: Devinsky
authors.forename: Ruben
authors.initials: R
authors.lastname: Kuzniecky
authors.forename: Frank
authors.initials: F
authors.lastname: Gilliam
authors.forename: Fahad
authors.initials: F
authors.lastname: Pervez
authors.forename: Frank
authors.initials: F
authors.lastname: Provenzano
authors.forename: Stanley
authors.initials: S
authors.lastname: Goldsmith
authors.forename: Shankar
authors.initials: S
authors.lastname: Vallabhajosula
authors.forename: Emily
authors.initials: E
authors.lastname: Stern
authors.forename: David
authors.initials: D
authors.lastname: Silbersweig
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004660:Encephalitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D007546:Isoquinolines; D054220:Malformations of Cortical Development / Q000150:complications* / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals
chemical_list: D007546:Isoquinolines; D019275:Radiopharmaceuticals; C037850:PK 11195