Alpha-methyl-l-tryptophan positron emission tomography in epilepsy with cortical developmental malformations.
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.
Wakamoto
Hiroyuki
H
Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA.
Chugani
Diane C
DC
Juhász
Csaba
C
Muzik
Otto
O
Kupsky
William J
WJ
Chugani
Harry T
HT
D000293:Adolescent; D001921:Brain / Q000000981:diagnostic imaging; D002250:Carbon Radioisotopes; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000000981:diagnostic imaging / Q000209:etiology; D004827:Epilepsy / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D015203:Reproducibility of Results; D014364:Tryptophan / Q000008:administration & dosage / Q000031:analogs & derivatives
D002250:Carbon Radioisotopes; D019788:Fluorodeoxyglucose F18; C020774:alpha-methyltryptophan; D014364:Tryptophan