Richardson, Mark Philip; (1993) Positron emission tomography investigation of cortical malformations causing epilepsy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Positron emission tomography (PET) was employed to investigate the central benzodiazepine receptor (cBZR) system and cerebral blood flow in patients with malformations of cortical development (MCD) and other syndromes associated with epilepsy. Abnormalities of cortical cBZR binding were shown in 11 of 14 patients with MCD; 7 had abnormalities beyond the lesions seen with high-resolution MRI. These abnormalities consisted of both increases and decreases in cBZR binding. All six patients with acquired non-progressive cerebral injury had reduced cBZR binding in the lesion seen on MRI; in 2 cases the region of reduced cBZR was more extensive. All six patients with dysembryoplastic neuroepithelial tumour had reduced cBZR density in the region of brain affected on MRI. One subject had a single remote region of increased cBZR. Thirteen of 18 patients with extratemporal localisation-related epilepsy and normal MRI had regions of abnormal cortical cBZR; 10 had regions of increased cBZR, 6 had regions of decreased cBZR and 3 had both regions of increased and decreased cBZR. Six of 10 patients with unilateral frontal seizure onset had an abnormality in the implicated frontal lobe. Five of 10 patients with MCD had abnormalities of MRI volumetry; only these same five patients had abnormalities of regional grey matter volume using a voxel based automated technique. Six of 10 patients with MCD showed regions of cerebral cortex with disproportionate cBZR binding compared with local grey matter volume by integrating PET and MRI data at the voxel level. Changes in cBZR were seen in 10 patients with unilateral FLE and normal MRI in the cortical-basal ganglia motor system. Some regions showed abnormalities of cBZR correlating with seizure frequency. Eight of 10 patients with MCD showed activation of affected brain regions with appropriate tasks. In addition, there was a significant alteration in the overall activation pattern in five patients, compared with a normal control group.

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