Nuklearmedizinische Diagnostik in der Epilepsie

Zusammenfassung

Die prächirurgische Abklärung refraktärer fokaler Epilepsien hat das Ziel, den epileptogenen Fokus zu identifizieren und zu lokalisieren, und möglichst exakt das epileptogene Kortexareal von funktionell relevanten Kortexarealen abzugrenzen. Trotz hochauflösendem MRT findet sich jedoch bei 20 bis 50% fokaler Epilepsien kein pathologischer Befund. Diese kryptogenen Epilepsien sind die Hauptindikation für nuklearmedizinische Zusatzverfahren zur Identifizierung des epileptogenen Fokus. PET und SPECT können bei der Abklärung von therapierefraktären Epilepsiepatienten hilfreich sein, wenn das Oberflächen-EEG den Fokus nicht lokalisieren oder lateralisieren kann. Zusätzlich werden nuklearmedizinische Verfahren benötigt, wenn die Ergebnisse iktualer Anfallsaufzeichnung nicht mit der Bildgebung übereinstimmen, diskordant sind, oder aber Hinweise auf mehr als eine Läsion oder Fokus im Sinne einer „duale Pathologie“ bestehen.

Summary

The aim of presurgical evaluation is to identify and localise the epileptogenic focus, and define its borders towards functionally eloquent cortex. Despite high-resolution MRI, an epileptogenic lesion cannot be identified in 20 to 50% of focal chronic epilepsies. These socalled cryptogenic epilepsies are the main indication for nuclear medicine studies. Furthermore, PET and SPECT can be helpful during the evaluation of drug-resistant patients, if surface EEG cannot lateralize nor localize the epileptogenic focus. Even in the presence of a lesion, these nuclear medicine studies are necessary, if EEG findings are either discordant with the MRI findings or if there is evidence for multiple lesions or foci, so-called “dual pathology”.

Schlüsselwörter

Therapierefraktäre Epilepsie - FDG - 11C-Flumazenil

Keywords

Refractory epilepsy - FDG - 11C-Flumazenil

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