A two-part article written by two Wayne State University School of Medicine faculty members at the request of a leading imaging journal provides a comprehensive review of the role of radionuclide imaging in epilepsy.

Assistant Professor of pediatrics and of neurology Ajay Kumar, M.D., Ph.D., is the first and corresponding author, and Rosalie and Bruce Rosen Professor of neurology Harry Chugani, M.D., is the senior author on the articles published in the Aug. 22 and Sept. 12 issues of the Journal of Nuclear Medicine, the official publication of the Society of Nuclear Medicine and Molecular Imaging.

"We are happy with such positive feedback and attention, as it suggests quite an interest and awareness for molecular imaging, particularly positron emission tomography," Dr. Kumar said.

The work was listed as the top article in the society's SmartBrief summary of news, and was extensively featured on MolecularImaging.net and other websites.

The duo was invited to critically review the use of molecular imaging of epilepsy and epileptic syndrome using positron emission tomography based on their own extensive history of work, research and experience, along with other scientists' published results.

Reviewers often write about the status, state of the art, limitations and possible improvements of a given field, such as diagnostics, therapy, drug developments, patient management and quality of life improvement, Dr. Kumar said. "These suggestions usually shape the discussion and guide the future direction of the research, as well as formulation of current practices and guidelines," he added.

The articles also are designed to teach and inform other physicians, researchers, residents, fellows and medical professionals.

In "The role of radionuclide imaging in epilepsy, part 1: sporadic temporal and extratemporal lobe epilepsy," the authors weigh in on PET's potential for mapping epilepsy in the brain, specifically two types called sporadic temporal and extratemporal lobe epilepsy.

Dr. Chugani is chief of the WSU Division of Pediatric Neurology and director of the PET Center at Children's Hospital of Michigan.

Epilepsy is one of the most common yet diverse neurologic disorders, affecting 1 percent to 2 percent of the population. Radionuclide imaging such as PET and single-photon emission computerized tomography, or SPECT, is not used in the primary diagnosis or evaluation of recent-onset epilepsy, but can play an important role in specific situations. They include in noninvasive pre-surgical localization of epileptogenic brain regions in intractable-seizure patients being considered for epilepsy surgery.

According to the article, almost one-fourth of epileptic patients do not respond to medical treatment and develop these seizures, which are difficult to control with medication.

They write that radionuclide imaging can be particularly useful if magnetic resonance imaging is either negative for lesions or shows several lesions of which less than two are suspected to be epileptogenic, and if electroencephalogram changes are unclear or conflict with the structural imaging.

PET and SPECT, both molecular imaging techniques, are capable of imaging and evaluating any organ or system at molecular level, providing functional information at a cellular or sub-cellular level, compared to traditional radiological imaging techniques, such as CT scan or MRI, which can provide structural information only.

PET and SPECT can also be useful for evaluating the functional integrity of the rest of the brain and may provide useful information on the possible pathogenesis of the neurocognitive and behavioral abnormalities frequently observed in these patients, they said.

In "The role of Radionuclide Imaging in Epilepsy, Part 2: Epilepsy syndromes," the authors contend that PET and SPECT also can play an important role in the evaluation of various epileptic syndromes, particularly those with unknown causes, by revealing various underlying abnormalities that may not be appreciated in MRI studies. In some cases, PET and SPECT provide crucial data that guide surgical resections of the epileptogenic zone for medically refractory epilepsy. In other cases, these neuroimaging modalities preclude a surgical option and can guide genetic studies. "Longitudinal PET and SPECT studies may increase our understanding of the etiopathogenesis of epilepsy syndromes and provide a clearer picture of the natural history of neurologic progression," Drs. Kumar and Chugani wrote.