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Alpha-Methyl-l-Tryptophan Positron Emission Tomography in Epilepsy With Cortical Developmental Malformations

Authors
Journal
Pediatric Neurology
0887-8994
Publisher
Elsevier
Publication Date
Volume
39
Issue
3
Identifiers
DOI: 10.1016/j.pediatrneurol.2008.05.014
Disciplines
  • Medicine

Abstract

Preliminary studies suggest that alpha[ 11C]methyl- l-tryptophan positron emission tomography can detect the epileptic focus within malformations of cortical development. We determined the sensitivity and specificity of alpha-[ 11C]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-[ 11C]methyl- l-tryptophan uptake. The sensitivity and specificity of focal increased alpha-[ 11C]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-[ 11C]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-[ 11C]methyl- l-tryptophan uptake abnormality was higher in the lesional than the nonlesional group ( P < 0.01). Alpha-[ 11C]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-[ 11C]methyl- l-tryptophan positron emission tomography in identifying neocortical epileptic focus is modest, specificity is extremely high. When an alpha-[ 11C]methyl- l-tryptophan focus is detected, it likely represents the epileptogenic region to be resected.

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