title: Successful surgical treatment of an inflammatory lesion associated with new-onset refractory status epilepticus.
abstract: New-onset refractory status epilepticus (NORSE) has high morbidity and mortality. The authors describe the successful surgical treatment of a 56-year-old man presenting with NORSE. Magnetic resonance imaging showed a left temporal lobe lesion suspicious for a low-grade tumor, while PET imaging with the alpha[(11)C]methyl-L-tryptophan (AMT) radiotracer showed increased cortical uptake extending beyond this lesion and partly overlapping with epileptogenic cortex mapped by chronic intracranial electroencephalographic monitoring. Resection of the epileptic focus resulted in long-term seizure freedom, and the nonresected portion of the PET-documented abnormality normalized. Histopathology showed reactive gliosis and inflammatory markers in the AMT-PET-positive cortex. Molecular imaging of neuroinflammation can be instrumental in the management of NORSE by guiding placement of intracranial electrodes or assessing the extent and severity of inflammation for antiinflammatory interventions.
authors.affiliation: Department of Pediatrics, Wayne State University; Detroit, MI 48201, USA.
authors.forename: Csaba
authors.initials: C
authors.lastname: Juhász
authors.forename: Amy
authors.initials: A
authors.lastname: Buth
authors.forename: Diane C
authors.initials: DC
authors.lastname: Chugani
authors.forename: William J
authors.initials: WJ
authors.lastname: Kupsky
authors.forename: Harry T
authors.initials: HT
authors.lastname: Chugani
authors.forename: Aashit K
authors.initials: AK
authors.lastname: Shah
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mittal
mesh_terms: D002250:Carbon Radioisotopes; D004569:Electroencephalography; D004660:Encephalitis / Q000209:etiology* / Q000601:surgery*; D005904:Glial Fibrillary Acidic Protein / Q000378:metabolism; D006801:Humans; D053583:Interleukin-1beta / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D049268:Positron-Emission Tomography; D013226:Status Epilepticus / Q000150:complications*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000601:surgery; D014364:Tryptophan / Q000031:analogs & derivatives
chemical_list: D002250:Carbon Radioisotopes; D005904:Glial Fibrillary Acidic Protein; D053583:Interleukin-1beta; C028129:tryptophan methyl ester; D014364:Tryptophan