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2015 ; 5
(5
): 416-30
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PET studies in epilepsy
#MMPMID26550535
Sarikaya I
Am J Nucl Med Mol Imaging
2015[]; 5
(5
): 416-30
PMID26550535
show ga
Various PET studies, such as measurements of glucose, serotonin and oxygen
metabolism, cerebral blood flow and receptor bindings are availabe for epilepsy.
(18)Fluoro-2-deoxyglucose ((18)F-FDG) PET imaging of brain glucose metabolism is
a well established and widely available technique. Studies have demonstrated that
the sensitivity of interictal FDG-PET is higher than interictal SPECT and similar
to ictal SPECT for the lateralization and localization of epileptogenic foci in
presurgical patients refractory to medical treatments who have noncontributory
EEG and MRI. In addition to localizing epileptogenic focus, FDG-PET provide
additional important information on the functional status of the rest of the
brain. The main limitation of interictal FDG-PET is that it cannot precisely
define the surgical margin as the area of hypometabolism usually extends beyond
the epileptogenic zone. Various neurotransmitters (GABA, glutamate, opiates,
serotonin, dopamine, acethylcholine, and adenosine) and receptor subtypes are
involved in epilepsy. PET receptor imaging studies performed in limited centers
help to understand the role of neurotransmitters in epileptogenesis, identify
epileptic foci and investigate new treatment approaches. PET receptor imaging
studies have demonstrated reduced (11)C-flumazenil (GABAA-cBDZ) and (18)F-MPPF
(5-HT1A serotonin) and increased (11)C-cerfentanil (mu opiate) and (11)C-MeNTI
(delta opiate) bindings in the area of seizure. (11)C-flumazenil has been
reported to be more sensitive than FDG-PET for identifying epileptic foci. The
area of abnormality on GABAAcBDZ and opiate receptor images is usually smaller
and more circumscribed than the area of hypometabolism on FDG images. Studies
have demonstrated that (11)C-alpha-methyl-L-tryptophan PET (to study synthesis of
serotonin) can detect the epileptic focus within malformations of cortical
development and helps in differentiating epileptogenic from non-epileptogenic
tubers in patients with tuberous sclerosis complex. (15)O-H2O PET was reported to
have a similar sensitivity to FDG-PET in detecting epileptic foci.