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Kumar A, Shandal V, Juhász C, Chugani HT. PET imaging in epilepsy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Burgos DF, Cussó L, Sánchez-Elexpuru G, Calle D, Perpinyà MB, Desco M, Serratosa JM, Sánchez MP. Structural and Functional Brain Abnormalities in Mouse Models of Lafora Disease. Int J Mol Sci 2020; 21:ijms21207771. [PMID: 33092303 PMCID: PMC7589150 DOI: 10.3390/ijms21207771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Mutations in the EPM2A and EPM2B genes, encoding laforin and malin proteins respectively, are responsible for Lafora disease, a fatal form of progressive myoclonus epilepsy with autosomal recessive inheritance. Neuroimaging studies of patients with Lafora disease have shown different degrees of brain atrophy, decreased glucose brain uptake and alterations on different brain metabolites mainly in the frontal cortex, basal ganglia and cerebellum. Mice deficient for laforin and malin present many features similar to those observed in patients, including cognitive, motor, histological and epileptic hallmarks. We describe the neuroimaging features found in two mouse models of Lafora disease. We found altered volumetric values in the cerebral cortex, hippocampus, basal ganglia and cerebellum using magnetic resonance imaging (MRI). Positron emission tomography (PET) of the cerebral cortex, hippocampus and cerebellum of Epm2a-/- mice revealed abnormal glucose uptake, although no alterations in Epm2b-/- mice were observed. Magnetic resonance spectroscopy (MRS) revealed significant changes in the concentration of several brain metabolites, including N-acetylaspartate (NAA), in agreement with previously described findings in patients. These data may provide new insights into disease mechanisms that may be of value for developing new biomarkers for diagnosis, prevention and treatment of Lafora disease using animal models.
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Affiliation(s)
- Daniel F. Burgos
- Laboratory of Neurology, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Autónoma University, 28040 Madrid, Spain; (D.F.B.); (G.S.-E.); (M.B.P.); (J.M.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Lorena Cussó
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Madrid, Spain; (L.C.); (M.D.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Unidad de Imagen Avanzada, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Gentzane Sánchez-Elexpuru
- Laboratory of Neurology, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Autónoma University, 28040 Madrid, Spain; (D.F.B.); (G.S.-E.); (M.B.P.); (J.M.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, UK
| | - Daniel Calle
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Unidad de Imagen Avanzada, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Max Bautista Perpinyà
- Laboratory of Neurology, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Autónoma University, 28040 Madrid, Spain; (D.F.B.); (G.S.-E.); (M.B.P.); (J.M.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Manuel Desco
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, 28911 Madrid, Spain; (L.C.); (M.D.)
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28029 Madrid, Spain
- Unidad de Imagen Avanzada, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - José M. Serratosa
- Laboratory of Neurology, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Autónoma University, 28040 Madrid, Spain; (D.F.B.); (G.S.-E.); (M.B.P.); (J.M.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Marina P. Sánchez
- Laboratory of Neurology, Fundación Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Autónoma University, 28040 Madrid, Spain; (D.F.B.); (G.S.-E.); (M.B.P.); (J.M.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
- Correspondence: ; Tel./Fax: +34-91-5497700
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Muccioli L, Farolfi A, Pondrelli F, d'Orsi G, Michelucci R, Freri E, Canafoglia L, Licchetta L, Toni F, Bonfiglioli R, Civollani S, Pettinato C, Maietti E, Marotta G, Fanti S, Tinuper P, Bisulli F. FDG-PET assessment and metabolic patterns in Lafora disease. Eur J Nucl Med Mol Imaging 2019; 47:1576-1584. [PMID: 31858178 DOI: 10.1007/s00259-019-04647-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/02/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To describe cerebral glucose metabolism pattern as assessed by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in Lafora disease (LD), a rare, lethal form of progressive myoclonus epilepsy caused by biallelic mutations in EPM2A or NHLRC1. METHODS We retrospectively included patients with genetically confirmed LD who underwent FDG-PET scan referred to three Italian epilepsy centers. FDG-PET images were evaluated both visually and using SPM12 software. Subgroup analysis was performed on the basis of genetic and clinical features employing SPM. Moreover, we performed a systematic literature review of LD cases that underwent FDG-PET assessment. RESULTS Eight Italian patients (3M/5F, 3 EPM2A/5 NHLRC1) underwent FDG-PET examination after a mean of 6 years from disease onset (range 1-12 years). All patients showed bilateral hypometabolic areas, more diffuse and pronounced in advanced disease stages. Most frequently, the hypometabolic regions were the temporal (8/8), parietal (7/8), and frontal lobes (7/8), as well as the thalamus (6/8). In three cases, the FDG-PET repeated after a mean of 17 months (range 7-36 months) showed a metabolic worsening compared with the baseline examination. The SPM subgroup analysis found no significant differences based on genetics, whereas it showed a more significant temporoparietal hypometabolism in patients with visual symptoms compared with those without. In nine additional cases identified from eight publications, FDG-PET showed heterogeneous findings, ranging from diffusely decreased cerebral glucose metabolism to unremarkable examinations in two cases. CONCLUSIONS FDG-PET seems highly sensitive to evaluate LD at any stage and may correlate with disease progression. Areas of decreased glucose metabolism in LD are extensive, often involving multiple cortical and subcortical regions, with thalamus, temporal, frontal, and parietal lobes being the most severely affected. Prospective longitudinal collaborative studies are needed to validate our findings.
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Affiliation(s)
- Lorenzo Muccioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Andrea Farolfi
- Nuclear Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Federica Pondrelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe d'Orsi
- Epilepsy Centre, Clinic of Nervous System Diseases, Ospedali Riuniti, University of Foggia, Foggia, Italy
| | - Roberto Michelucci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Canafoglia
- Department of Neurophysiology and Diagnostic Epileptology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Francesco Toni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Rachele Bonfiglioli
- Nuclear Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | | | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giorgio Marotta
- Nuclear Medicine Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Stefano Fanti
- Nuclear Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. .,IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy.
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Chugani HT. Positron Emission Tomography in Pediatric Neurodegenerative Disorders. Pediatr Neurol 2019; 100:12-25. [PMID: 31416725 DOI: 10.1016/j.pediatrneurol.2019.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022]
Abstract
Application of molecular neuroimaging using positron emission tomographic techniques to assess pediatric neurodegenerative disorders has been limited, unlike in adults where positron emission tomography has contributed to clinical diagnosis, monitoring of neurodegenerative disease progression, and assessment of novel therapeutic approaches. Yet, there is a huge unexplored potential of molecular imaging to improve our understanding of the pathophysiology of neurodegenerative disorders in children and provide radiological biomarkers that can be applied clinically. The obstacles in performing PET scans on children include sedation, radiation exposure, and access but, as will be illustrated, these barriers can be easily overcome. This review summarizes findings from PET studies that have been performed over the past three decades on children with various neurodegenerative disorders, including the neuronal ceroid lipofuscinoses, juvenile Huntington disease, Wilson disease, Niemann-Pick disease type C, Dravet syndrome, dystonia, mitochondrial disorders, inborn errors of metabolism, lysosomal storage diseases, dysmyelinating disorders, Rett syndrome, neurotransmitter disorders, glucose transporter Glut 1 deficiency, and Lesch-Nyhan disease. Because positron emission tomographic scans have often been clinically useful and have contributed to the management of these disorders, we suggest that the time has come for glucose metabolism positron emission tomographic scans to be reimbursed by insurance carriers for children with neurodegenerative disorders, and not restricted only to epilepsy surgery evaluation.
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Affiliation(s)
- Harry T Chugani
- Department of Neurology, NYU School of Medicine, New York, New York.
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Elkins KC, Moncayo VM, Kim H, Olson LD. Utility of gray-matter segmentation of ictal-Interictal perfusion SPECT and interictal 18 F-FDG-PET in medically refractory epilepsy. Epilepsy Res 2017; 130:93-100. [DOI: 10.1016/j.eplepsyres.2017.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/01/2017] [Accepted: 01/24/2017] [Indexed: 12/20/2022]
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Rathore C, Dickson JC, Teotónio R, Ell P, Duncan JS. The utility of 18F-fluorodeoxyglucose PET (FDG PET) in epilepsy surgery. Epilepsy Res 2014; 108:1306-14. [PMID: 25043753 DOI: 10.1016/j.eplepsyres.2014.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/12/2014] [Accepted: 06/28/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the utility of 18F-fluorodeoxyglucose Positron Emission Tomography (FDG PET) in helping decision making for epilepsy surgery. METHODS All patients with medically refractory focal epilepsy and MRI that was normal or discordant with clinical and EEG data underwent FDG PET. FDG PET scans were reported by two investigators blinded to clinical data using visual assessment aided by the semiquantitative assessment. All clinical, MRI and FDG PET data were reviewed in the multidisciplinary patient management conferences for the localization and further decisions, which were recorded in the electronic database. For this study, we reviewed the charts of all these patients to decide the usefulness of PET in further decision making. FDG PET was considered to be useful if led directly to surgery, helped in planning intracranial EEG or helped in excluding patients from further evaluation. RESULTS 194 consecutive adult patients (median age, 32.5 years) underwent FDG PET; 158 had normal MRI, 12 had subtle MRI abnormalities and 24 had discordant non-invasive data. Final localization was temporal lobe epilepsy (TLE, n=64), frontal lobe epilepsy (FLE, n=66), temporal-plus epilepsy (n=26) and other extratemporal lobe epilepsies (ETE, n=38). PET scans were normal in 72 (37%) patients, showed unifocal hypometabolism in 98 (50.5%) and bilateral hypometabolism in 24 (12%) patients. The TLE group had a higher proportion of abnormal PET scans (67%) than FLE (52%) and ETE (61%). PET data were useful in 103 (53%) patients, more in TLE (63%) than FLE (38%) or ETE (50%). It led directly to surgery in 12 (6%) cases, helped in planning intracranial EEG in 67 (35%) patients and excluded 24 (12%) patients from further evaluation. Focal hypometabolism on FDG PET increased the odds of being selected for surgery or intracranial EEG by five fold [odds ratio, 5.1 (2.8-9.4); p<0.0001]. CONCLUSIONS FDG PET scan can help decision making in 53% of presurgical patients with normal or discordant MRI. PET findings need to be evaluated in conjunction with other data.
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Affiliation(s)
- Chaturbhuj Rathore
- Department of Clinical and Experimental epilepsy, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - John C Dickson
- Institute of Nuclear Medicine, University College London Hospitals, London, UK.
| | - Rute Teotónio
- Department of Clinical and Experimental epilepsy, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Peter Ell
- Institute of Nuclear Medicine, University College London Hospitals, London, UK.
| | - John S Duncan
- Department of Clinical and Experimental epilepsy, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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Modern Techniques of Epileptic Focus Localization. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2014; 114:245-78. [DOI: 10.1016/b978-0-12-418693-4.00010-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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