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From the Departments of Neurology (Drs. Henry, Frey, Sackellares, Gilman, Brunberg, Berent, and Young), Internal Medicine (Drs. Frey, Koeppe, and Kuhl), Radiology (Drs. Brunberg and Kuhl), Surgery (Drs. Brunberg and Ross), and Psychiatry (Dr. Berent), University of Michigan Medical Center, Ann Arbor, MI.
Positron emission tomography measured interictal cerebral glucose metabolism with [18F]fluorodeoxyglucose and central benzodiazepine-receptor binding with [11C]flumazenil in 10 mesial temporal lobe epilepsy (TLE) patients and in normal subjects. Eight TLE patients had mesial temporal, lateral temporal, and thalamic hypometabolism ipsilateral to EEG ictal onsets, with additional extratemporal hypometabolism in four. One had unilateral anterior mesial temporal hypometabolism only, and one had normal metabolism. Each patient had decreased benzodiazepine-receptor binding in the ipsilateral anterior mesial temporal region, without neocortical changes. Thus, interictal metabolic dysfunction is variable and usually extensive in TLE, whereas decreased central benzodiazepine-receptor density is more restricted to mesial temporal areas. Metabolic patterns in TLE may reflect diaschisis, while benzodiazepine-receptor changes may reflect localized neuronal and synaptic loss that is specific to the epileptogenic zone. [11C]Flumazenil imaging maybe useful in presurgical evaluation of refractory complex partial seizures.
Address correspondence and reprint requests to Dr. J. Chris Sackellares, Department of Neurology, University of Michigan Medical Center, North Ingalls Building 3D06, 400 N. Ingalls, Ann Arbor, MI 48109.
Supported in part by the National Institutes of Health (N1NDS-P01 NS15655).
Received January 7, 1993. Accepted for publication in final form March 11, 1993.
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