• Tracy Butler, Masanori Ichise, Andrew F Teich, Elizabeth Gerard, Joseph Osborne, Jacqueline French, Orrin Devinsky, Ruben Kuzniecky, Frank Gilliam, Fahad Pervez, Frank Provenzano, Stanley Goldsmith, Shankar Vallabhajosula, Emily Stern, and David Silbersweig.
• New York University Comprehensive Epilepsy Center, School of Medicine, New York University, NY 10016, USA. Tracy.Butler@nyumc.org
• J Neuroimaging. 2013 Jan 1;23(1):129-31.

Background And PurposeEvidence from animal models and examination of human epilepsy surgery specimens indicates that inflammation plays an important role in epilepsy. Positron emission tomography (PET) using [C11]PK11195, a marker of activated microglia, provides a means to visualize neuroinflammation in vivo in humans. We hypothesize that in patients with active epilepsy, [C11]PK11195 PET (PK-PET) may be able to identify areas of focally increased inflammation corresponding to the seizure onset zone.MethodsA young woman with intractable epilepsy underwent PK-PET as part of an approved research study. PK-PET results were compared with results from other clinical studies.ResultsPK-PET revealed an area of focally increased radiotracer uptake in the right frontal lobe corresponding to this patient's seizure focus as identified by ictal and interictal 18F-fluorodeoxyglucose (FDG)-PET and EEG. Routine brain magnetic resonance imaging (MRI) was initially considered normal, though high-resolution studies showed possible subtle dysplasia of the right frontal lobe. The patient underwent a right frontal lobe resection, and pathological evaluation showed focal cortical dysplasia with activated microglia.ConclusionsPK-PET can identify neuroinflammation associated with subtle focal cortical dysplasia, and may therefore have a clinical role in guiding epilepsy surgery for patients with difficult-to-localize seizure foci.Copyright © 2011 by the American Society of Neuroimaging.

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