Central benzodiazepine receptors in hippocampal sclerosis and idiopathic generalised epilepsies and opiod receptors in reading epilepsy

Background: Epilepsy is the most common serious disease of the brain. In order to better understand the processes and neuronal circuits involved in the pathophysiology of the epilepsies and to provide structural / functional correlations, positron emission tomography (PET) needs to be evaluated in the light of high quality MRI. Aims: To determine the extent and amount of central benzodiazepine/GABAA receptor (cBZR) abnormalities in mesial temporal lobe epilepsy (mTLE) due to hippocampal sclerosis (HS); to quantify cBZR in idiopathic generalised epilepsy (IGE) and the effect of treatment with sodium valproate (VPA); to investigate dynamic changes of opioid receptors in reading epilepsy (RE) at the time of reading-induced seizures. Methods: 11C-flumazenil (FMZ)-PET scans of 37 controls, 25 candidates for temporal lobe resections with HS, and 10 patients with IGE before and after taking VPA, were analysed with statistical parametric mapping (SPM) and a partial-volume-effect (PVE) corrected regions-of-interest approach to quantify FMZ binding to cBZR. Paired 11C-diprenorphine (DPN)-PET scans of 6 control subjects and 5 patients with RE were analysed with SPM to detect significant localised reductions of DPN binding during reading-induced seizures implying a focal release of endogenous opioids. Results: Using SPM, reductions of cBZR were restricted to the sclerotic hippocampus in unilateral mTLE. Using PVE correction loss of cBZR in HS was shown to be over and above that due to neurone loss and hippocampal atrophy. In-vivo 1IC-FMZ-PET correlated well with ex-vivo 3H-FMZ autoradiography in HS. Subtle reductions of cBZR are seen contralaterally in unilateral mTLE in 30%. cBZR in IGE are increased in the cortex and thalamus, and FMZ binding is not affected by VPA. Endogenous opioids are released locally in the left temporo-parietal cortex at the time of reading-induced seizures. Conclusions: The identification of functional abnormalities of major inhibitory neurotransmitter systems, over and above structural abnormalities, has profound implications for the presurgical investigation of patients, in whom MRI does not reveal a relevant underlying lesion. Elucidation of the neurochemical and functional abnormalities underlying seizures assists the design of new anti-epileptic drugs and helps to identify neurochemical abnormalities underlying specific epilepsy syndromes