THE LIMITATIONS OF DIAGNOSING DRUG-RESISTANT EPILEPSY

Surgery is the only curative treatment for a third of patients with drug-resistant focal epilepsy. Precise prior localisation of the epileptogenic zone is crucial to the success of surgery, but it is a delicate operation. To achieve this, doctors currently use a combination of information:

• video recordings coupled with electroencephalograms ;
• moprhological data obtained by magnetic resonance imaging (MRI) ;
• information on metabolically active areas of the brain, obtained using ​[¹⁸F]FDG positron emission tomography (PET)
  

In 60% of cases, this pre-surgical assessment phase makes it possible to identify epileptogenic areas with a high degree of confidence and propose immediate surgery. The rest of the time, this is not possible, particularly when [¹⁸F]FDG PET is not sufficiently informative.

DPA-714, an additional tool

The [¹⁸F]DPA-714 radiotracer has recently been proposed as an interesting alternative to FDG. DPA-714 is a ligand for the TSPO protein, which is overproduced by activated glial cells and astrocytes during neuroinflammation, a phenomenon that occurs notably in epilepsy.

In a trial involving 23 people, the BioMaps laboratory (SHFJ), a leader in the use of [¹⁸F]DPA-714 in preclinical and clinical studies, has shown that [¹⁸F]DPA-714 PET provides more relevant information on the location of epileptogenic foci than [¹⁸F]FDG PET. This benefit has made it possible to surgically manage patients who would not have benefited from surgery with the results of FDG PET.

These results indicate that [¹⁸F]DPA-714 PET could be an additional tool for the best possible localisation of epileptogenic foci, particularly for patients for whom FDG PET is not informative.​

Co​​ntact :

Professor Viv​​iane Bouilleret (viviane.bouilleret@aphp.fr)