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Alpha-methyl-l-tryptophan positron emission tomography in epilepsy with cortical developmental malformations.

Abstract
Preliminary studies suggest that alpha[(11)C]methyl-l-tryptophan positron emission tomography can detect the epileptic focus within malformations of cortical development. We determined the sensitivity and specificity of alpha-[(11)C]methyl-l-tryptophan positron emission tomography in identifying epileptic focus in children with intractable, neocortical epilepsy with and without malformations of cortical development. Seventy-three epileptic children were classified into lesional and nonlesional groups, and compared regarding focal increased alpha-[(11)C]methyl-l-tryptophan uptake. The sensitivity and specificity of focal increased alpha-[(11)C]methyl-l-tryptophan uptake, using intracranial electroencephalogram localization of seizure onset as the standard, were compared between lesional and nonlesional groups. The specificity of alpha-[(11)C]methyl-l-tryptophan positron emission tomography for detecting seizure onset lobe was equally high in lesional (97%) and nonlesional groups (100%), whereas sensitivity was higher in the lesional than the nonlesional group (47% versus 29%; P = 0.047). The incidence of alpha-[(11)C]methyl-l-tryptophan uptake abnormality was higher in the lesional than the nonlesional group (P < 0.01). Alpha-[(11)C]methyl-l-tryptophan positron emission tomography localized and visualized epileptogenic regions in 25% of patients with nonlocalizing magnetic resonance imaging. Although overall sensitivity of alpha-[(11)C]methyl-l-tryptophan positron emission tomography in identifying neocortical epileptic focus is modest, specificity is extremely high. When an alpha-[(11)C]methyl-l-tryptophan focus is detected, it likely represents the epileptogenic region to be resected.
AuthorsHiroyuki Wakamoto, Diane C Chugani, Csaba Juhász, Otto Muzik, William J Kupsky, Harry T Chugani
JournalPediatric neurology (Pediatr Neurol) Vol. 39 Issue 3 Pg. 181-8 (Sep 2008) ISSN: 0887-8994 [Print] United States
PMID18725063 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Carbon Radioisotopes
  • Fluorodeoxyglucose F18
  • alpha-methyltryptophan
  • Tryptophan
Topics
  • Adolescent
  • Brain (radionuclide imaging)
  • Carbon Radioisotopes
  • Cerebral Cortex (radionuclide imaging)
  • Child
  • Child, Preschool
  • Electroencephalography
  • Epilepsies, Partial (etiology, radionuclide imaging)
  • Epilepsy (etiology, radionuclide imaging)
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Injections, Intravenous
  • Magnetic Resonance Imaging
  • Male
  • Malformations of Cortical Development (complications, radionuclide imaging)
  • Positron-Emission Tomography (methods)
  • Reproducibility of Results
  • Tryptophan (administration & dosage, analogs & derivatives)

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