Usefulness of 123I-iomazenil single-photon emission computed tomography in discriminating between mesial and lateral temporal lobe epilepsy in patients in whom magnetic resonance imaging demonstrates normal findings

View More View Less
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

To provide greater accuracy in determining the epileptogenic zone during preoperative evaluation, the authors retrospectively examined 123I-iomazenil single-photon emission computed tomography (IMZ SPECT) studies obtained in patients with temporal lobe epilepsy (TLE) in whom there was no evidence of an abnormality on magnetic resonance (MR) images.

Methods

Twelve patients, seven with mesial TLE (MTLE) and five with lateral TLE (LTLE), satisfied the criteria for inclusion in the study. The IMZ SPECT findings in these patients were reviewed retrospectively, and a comparison was made between findings in patients with MTLE and those in patients with LTLE.

Results

The IMZ SPECT studies demonstrated decreased IMZ uptake in the ipsilateral mesial temporal region and the anterobasal temporal lobe in all patients who had MTLE on only one side. On the other hand, IMZ SPECT examinations revealed low IMZ uptake in the ipsilateral lateral temporal lobe in four of five patients with LTLE in whom abnormal findings were restricted to the lateral neocortex. In the remaining patient with LTLE, abnormally low IMZ uptake was found in both mesial and lateral temporal lobes, although pure LTLE was diagnosed by an invasive electroencephalographic evaluation; this patient's habitual seizures continued even after temporal lobectomy, although his mesial structures were spared.

Conclusions

The authors report characteristics of IMZ SPECT findings that differed between patients with MTLE and those with LTLE. The IMZ SPECT examinations proved useful for preoperative evaluation and, to a certain extent, for discrimination between MTLE and LTLE in cases in which MR imaging demonstrated normal findings. The results of this study suggest that IMZ SPECT findings may reflect localization of the epileptogenic zone.

Abbreviations used in this paper:BZR = benzodiazepine receptor; CCTV-EEG = closed circuit television electroencephalography; FMZ PET = 11C-flumazenil positron emission tomography; HMPAO = 99mTc-hexamethyl propyleneamineoxime; IMZ SPECT = 123I-iomazenil single-photon emission computed tomography; LTLE = lateral temporal lobe epilepsy; MR = magnetic resonance; MTLE = mesial TLE; selAH = selective amygdalohippocampectomy.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Shuichi Umeoka, M.D., Ph.D., Department of Neurological Surgery, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, 886 Urushiyama, Shizuoka 420–8688, Japan. email: umesh@szec.hosp.go.jp.
  • 1

    Babb TL, , Brown WJ, , Pretorius J, , Davenport C, , Lieb JP, & Crandall PH: Temporal lobe volumetric cell densities in temporal lobe epilepsy. Epilepsia 25:729740, 1984

    • Search Google Scholar
    • Export Citation
  • 2

    Beer HF, , Blauenstein PA, , Hasler PH, , Dalaloye B, , Riccabona G, & Bangerl I, : In vitro and in vivo evaluation of iodine-123-ro 16–0514: a new imaging agent for SPECT investigations of benzodiazepine receptors. J Nucl Med 31:10071014, 1990

    • Search Google Scholar
    • Export Citation
  • 3

    Berkovic SF, , McIntosh AM, , Kalnins RM, , Jackson GD, , Fabinyi GC, & Brazenor GA, : Preoperative MRI predicts outcome of temporal lobectomy: an actuarial analysis. Neurology 45:13581363, 1995

    • Search Google Scholar
    • Export Citation
  • 4

    Doi T, , Matsuda K, , Mihara T, , Yagi W, & Seino S: [An analytic study of central benzodiazepine receptor in the surgically resected tissues of patients with intractable localization-related epilepsy. Quantitative analysis using 125I-iomazenil autoradiography.]. J Jpn Epil Soc 16:117126, 1998. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 5

    Engel J Jr, , Henry TR, , Risinger MW, , Maziotta JC, , Sutherling WW, & Levesque MF, : Preoperative evaluation for partial epilepsy: relative contributions of chronic depth electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG. Neurology 40:16701677, 1990

    • Search Google Scholar
    • Export Citation
  • 6

    Engel J Jr, , Van Ness PC, , Rasmussen TB, & Ojemann LM, Outcome with respect to epileptic seizures. Engel J Jr: Surgical Treatment of the Epilepsies ed 2 New York, Raven Press, 1993. 609622

    • Search Google Scholar
    • Export Citation
  • 7

    Goethals I, , Van de Wiele C, , Boon P, & Dierckx R: Is central benzo-diazepine receptor imaging useful for identification of epileptogenic foci in localization-related epilepsies?. Eur J Nucl Med Mol Imaging 30:325328, 2003

    • Search Google Scholar
    • Export Citation
  • 8

    Hajek M, , Antonini A, , Leenders KL, & Wieser HG: Mesiobasal versus lateral temporal lobe epilepsy: metabolic differences in the temporal lobe shown by interictal 18F-FDG positron emission tomography. Neurology 43:7986, 1993

    • Search Google Scholar
    • Export Citation
  • 9

    Hammen T, , Kerling F, , Schwarz M, , Stadlbauer A, , Ganslandt O, & Keck B, : Identifying the affected hemisphere by (1)H-MR spectroscopy in patients with temporal lobe epilepsy and no pathological findings in high resolution MRI. Eur J Neurol 13:482490, 2006

    • Search Google Scholar
    • Export Citation
  • 10

    Hand KS, , Baird VH, , Van Paesschen W, , Koepp MJ, , Revesz T, & Thom M, : Central benzodiazepine receptor autoradiography in hippocampal sclerosis. Br J Pharmacol 122:358364, 1997

    • Search Google Scholar
    • Export Citation
  • 11

    Hommer DW, , Skolnick P, & Paul SM, The benzodiazepine/GABA receptor complex and anxiety. Meltzer HY: Psychopharmacology: The Third Generation of Progress New York, Raven Press, 1987. 977983

    • Search Google Scholar
    • Export Citation
  • 12

    Johnson EW, , de Lanerolle NC, , Kim JH, , Sundaresan S, , Spencer DD, & Mattson RH, : “Central” and “peripheral” benzodiazepine receptors: opposite change in human epileptogenic tissue”. Neurology 42:811815, 1992

    • Search Google Scholar
    • Export Citation
  • 13

    Johnson EW, , Woods SW, , Zoghbi S, , McBride BJ, , Baldwin RM, & Innis RB: Receptor binding characterization of the benzodiazepine radioligand 125I-Ro16–0154: potential probe SPECT brain imaging. Life Sci 47:15351546, 1990

    • Search Google Scholar
    • Export Citation
  • 14

    Koepp MJ, , Hammers A, , Labbe C, , Woermann FG, , Brooks DJ, & Duncan JS, : 11C-flumazenil PET in patients with refractory temporal lobe epilepsy and normal MRI. Neurology 54:332339, 2000

    • Search Google Scholar
    • Export Citation
  • 15

    Kurokawa K, , Jibiki I, , Matsuda H, , Fukushima T, , Tsuji S, & Yamaguchi N, : Comparison of benzodiazepine receptor and regional cerebral blood flow imaging of epileptiform foci in hip-pocampal kindled rabbits: a study with in vivo double tracer autoradiography using 125I-iomazenil and 99mTc-HMPAO. Brain Res 642:303310, 1994

    • Search Google Scholar
    • Export Citation
  • 16

    Lamusuo S, , Ruottinen HM, , Knuuti J, , Harkonen R, , Ruotsalainen U, & Bergman J, : Comparison of [18F]-FDG-PET, [99mTc]-HMPAO-SPECT, and [123I]-iomazenil-SPECT in localising the epileptogenic cortex. J Neurol Neurosurg Psychiatry 63:743748, 1997

    • Search Google Scholar
    • Export Citation
  • 17

    Matsuda K, , Matsuda HM, , Morimoto KM, & Torizuka KT: Multicentre trial 123I-Iomazenil SPECT in Japan: clinical efficacy on localization of epileptic foci in refractory partial epilepsy. Epilepsia 44:8 Suppl 63, 2003. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 18

    Meiners LC, , van Gils A, , Jansen GH, , de Kort G, , Witkamp TD, & Ramos LM, : Temporal lobe epilepsy: the various MR appearances of histologically proven mesial temporal sclerosis. AJNR Am J Neuroradiol 15:15471555, 1994

    • Search Google Scholar
    • Export Citation
  • 19

    Mihara T, & Baba K, Combined use of subdural and depth electrodes. Lüders HO, & Comair YG: Epilepsy Surgery ed 2 Philadelphia, Lippincott, 2001. 613621

    • Search Google Scholar
    • Export Citation
  • 20

    Mihara T, , Matsuda K, , Tottori T, , Baba K, , Inoue Y, & Hiyoshi T, : Conditions for omitting invasive long-term monitoring before surgical resection in patients with temporal lobe epilepsy. Jpn J Psychiatry Neurol 46:323329, 1992

    • Search Google Scholar
    • Export Citation
  • 21

    Nagata T, , Tanaka F, , Yonekura Y, , Ikeda A, , Nishizawa S, & Ishizu K, : Limited value of interictal brain perfusion SPECT for detection of epileptic foci: high resolution SPECT studies in comparison with FDG-PET. Ann Nucl Med 9:5963, 1995

    • Search Google Scholar
    • Export Citation
  • 22

    Ryvlin P, , Bouvard S, , Le Bars D, , De Lamerie G, , Gregoire MC, & Kahane P, : Clinical utility of flumazenil-PET versus [18F]fluorodeoxyglucose-PET and MRI in refractory partial epilepsy. A prospective study in 100 patients. Brain 121:20672081, 1998

    • Search Google Scholar
    • Export Citation
  • 23

    Ryvlin P, , Guenot M, , Isnard J, , Sindou M, , Comar D, & Froment JC, : The role of the temporopolar cortex in temporal lobe epilepsy. Stereotact Funct Neurosurg 67:143, 1997. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 24

    Sackellares JC, , Siegel GJ, , Abou-Khalil BW, , Hood TW, , Gilman S, & McKeever PE, : Differences between lateral and mesial temporal metabolism interictally in epilepsy of temporal origin. Neurology 40:14201426, 1990

    • Search Google Scholar
    • Export Citation
  • 25

    Savic I, , Persson A, , Roland P, , Pauli S, , Sedvall G, & Widen L: In-vivo demonstration of reduced benzodiazepine receptor binding in human epileptic foci. Lancet 2:863866, 1988

    • Search Google Scholar
    • Export Citation
  • 26

    Semah F, , Baulac M, , Hasboun D, , Frouin V, , Mangin JF, & Papa-georgiou S, : Is interictal temporal hypometabolism related to mesial temporal sclerosis? A positron emission tomography/magnetic resonance imaging confrontation. Epilepsia 36:447456, 1995

    • Search Google Scholar
    • Export Citation
  • 27

    Sjoholm H, , Rosen I, & Elmqvist D: Role of I-123-iomazenil SPECT imaging in drug resistant epilepsy with complex partial seizures. Acta Neurol Scand 92:4148, 1995

    • Search Google Scholar
    • Export Citation
  • 28

    Spencer SS: The relative contributions of MRI, SPECT, and PET imaging in epilepsy. Epilepsia 35:6 Suppl S72S89, 1994

  • 29

    Tanaka F, , Yonekura Y, , Ikeda A, , Terada K, , Mikuni N, & Nishizawa S, : Presurgical identification of epileptic foci with iodine-123 iomazenil SPET: comparison with brain perfusion SPET and FDG PET. Eur J Nucl Med 24:2734, 1997

    • Search Google Scholar
    • Export Citation
  • 30

    Torizuka K, , Uemura K, , Tohoru M, , Yonekura Y, , Nakagawa J, & Fukuyama H, : [Phase 2 clinical study of 123I-iomazenil in various cerebral disease: part 1—examination of injection dose and clinical indications.]. Kaku Igaku 33:179190, 1996. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 31

    Van Paesschen W, , Connelly A, , King MD, , Jackson GD, & Duncan JS: The spectrum of hippocampal sclerosis: a quantitative magnetic resonance imaging study. Ann Neurol 41:4151, 1997

    • Search Google Scholar
    • Export Citation
  • 32

    Wieser HG, & Yaşargil MG: [“Selective amygdalo-hippocampectomy” as a surgical treatment of mesiobasal limbic epilepsy.]. Neurochirurgia (Stutt) 25:3950, 1982. (Ger)

    • Search Google Scholar
    • Export Citation
  • 33

    Willmann O, , Wennberg R, , May T, , Woermann FG, & Pohlmann-Eden B: The role of 1H magnetic resonance spectroscopy in pre-operative evaluation for epilepsy surgery. A meta-analysis. Epilepsy Res 71:149158, 2006

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 222 133 3
Full Text Views 127 3 1
PDF Downloads 89 3 1
EPUB Downloads 0 0 0