Abstract:
BACKGROUND:Alpha-[11C]methyl-L-tryptophan (alpha-MTrp) positron emission tomography (PET) is a promising tool in the localization of the epileptogenic area in selected group of focal epilepsy patients. Electrophysiological evidence suggests the involvement of the neocortex in periventricular nodular heterotopia (PVNH). PURPOSE:To determine whether alpha-MTrp PET can detect neocortical changes in patients with PVNH. METHODS:Four patients (2 male, mean age 28, range 23-35 years) with PVNH and intractable seizures were studied. The functional image in each patient was compared with those from 21 healthy controls (mean age 34.6 +/- 14.2 years) by using statistical parametric mapping (SPM). The location of increased alpha-MTrp uptake was compared with the location of the EEG focus. A significant cluster was defined as a cluster with a height p = 0.005 and an extent threshold 100. RESULTS:Alpha-MTrp PET revealed increased cortical uptake in two of four patients. The area of increased alpha-MTrp uptake in one patient was widespread. In the other patient, the area of increased uptake did not include the region where most seizures were generated on EEG. alpha-MTrp PET did not show increased uptake in the heterotopic nodules in any of the patients. CONCLUSIONS:Alpha-MTrp PET suggests abnormal metabolism of tryptophan in the neocortex. The increased uptake may be diffuse and may not co-localize with the EEG focus. This preliminary study suggests that alpha-MTrp PET may be useful, in conjunction with other evaluations, in localizing epileptic focus in patients with PVNH and refractory seizures.
journal_name
Epilepsiajournal_title
Epilepsiaauthors
Natsume J,Bernasconi N,Aghakhani Y,Kumakura Y,Nishikawa M,Fedi M,Soualmi L,Dubeau F,Andermann F,Bernasconi A,Diksic Mdoi
10.1111/j.1528-1167.2008.01575.xsubject
Has Abstractpub_date
2008-05-01 00:00:00pages
826-31issue
5eissn
0013-9580issn
1528-1167pii
EPI1575journal_volume
49pub_type
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