Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy

O. Muzik, E. A. Da Silva, C. Juhasz, D. C. Chugani, J. Shah, F. Nagy, A. Canady, H. M. Von Stockhausen, K. Herholz, J. Gates, M. Frost, F. Ritter, Craig Watson, Harry T. Chugani

Research output: Contribution to journalArticle

111 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)171-179
Number of pages9
JournalNeurology
Volume54
Issue number1
StatePublished - Jan 11 2000
Externally publishedYes

Fingerprint

Flumazenil
Epilepsy
Glucose
Seizures
ROC Curve
Fluorodeoxyglucose F18
Electrodes
Electrocorticography
Positron-Emission Tomography
Electroencephalography

Keywords

  • Epilepsy surgery
  • Extratemporal epilepsy
  • Flumazenil
  • Glucose metabolism
  • PET

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Muzik, O., Da Silva, E. A., Juhasz, C., Chugani, D. C., Shah, J., Nagy, F., ... Chugani, H. T. (2000). Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy. Neurology, 54(1), 171-179.

Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy. / Muzik, O.; Da Silva, E. A.; Juhasz, C.; Chugani, D. C.; Shah, J.; Nagy, F.; Canady, A.; Von Stockhausen, H. M.; Herholz, K.; Gates, J.; Frost, M.; Ritter, F.; Watson, Craig; Chugani, Harry T.

In: Neurology, Vol. 54, No. 1, 11.01.2000, p. 171-179.

Research output: Contribution to journalArticle

Muzik, O, Da Silva, EA, Juhasz, C, Chugani, DC, Shah, J, Nagy, F, Canady, A, Von Stockhausen, HM, Herholz, K, Gates, J, Frost, M, Ritter, F, Watson, C & Chugani, HT 2000, 'Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy', Neurology, vol. 54, no. 1, pp. 171-179.
Muzik O, Da Silva EA, Juhasz C, Chugani DC, Shah J, Nagy F et al. Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy. Neurology. 2000 Jan 11;54(1):171-179.
Muzik, O. ; Da Silva, E. A. ; Juhasz, C. ; Chugani, D. C. ; Shah, J. ; Nagy, F. ; Canady, A. ; Von Stockhausen, H. M. ; Herholz, K. ; Gates, J. ; Frost, M. ; Ritter, F. ; Watson, Craig ; Chugani, Harry T. / Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy. In: Neurology. 2000 ; Vol. 54, No. 1. pp. 171-179.
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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.",
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T1 - Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy

AU - Muzik, O.

AU - Da Silva, E. A.

AU - Juhasz, C.

AU - Chugani, D. C.

AU - Shah, J.

AU - Nagy, F.

AU - Canady, A.

AU - Von Stockhausen, H. M.

AU - Herholz, K.

AU - Gates, J.

AU - Frost, M.

AU - Ritter, F.

AU - Watson, Craig

AU - Chugani, Harry T.

PY - 2000/1/11

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N2 - 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.

AB - 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.

KW - Epilepsy surgery

KW - Extratemporal epilepsy

KW - Flumazenil

KW - Glucose metabolism

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