​Resective surgery is the only curative treatment for a third of patients with drug-resistant focal epilepsy (DRFE). Precise prior localisation of the epileptogenic zone (EZ) is crucial to the success of surgery, but this is delicate and requires a thorough assessment combining several pieces of information : i) electroencephalography (EEG); ii) morphological MRI data; iii) localisation of metabolically active brain areas by ¹⁸F-Fluorodeoxyglucose PET scan, [¹⁸F]-FDG-PET. When these first-line non-invasive assessments are inconclusive, further investigations such as intracranial stereo-EEG (SEEG) are necessary.

In this study, the researchers explored the integration of an innovative PET imaging technique, TSPO- PET, based on the use of [¹⁸F]DPA-714, with SEEG. They showed that there was a strong correlation between markers of neuroinflammation revealed by TSPO-PET imaging and epileptogenicity mappings obtained from intracranial SEEG recordings in 17 patients with DRFE. These results suggest that TSPO-PET could be a valuable non-invasive tool in pre-surgical assessments, particularly in complex or non-lesional cases of DRFE.

TSPO-PET imaging therefore appears very promising for locating the epileptogenic zone more precisely and non-invasively, and therefore for the success of epilepsy surgery, giving rise to the hope that in the long term, in certain situations, it will be possible to do away with the need for SEEG.

Contact : Professor Viviane Bouilleret (viviane.bouilleret@aphp.fr)