α-[11C]-methyl-L-tryptophan PET identifies the epileptogenic tuber and correlates with interictal spike frequency

Marco Fedi, David C. Reutens, Frederick Andermann, Hidehiko Okazawa, Warren Boling, Carole White, François Dubeau, Akio Nakai, Donald W. Gross, Eva Andermann, Mirko Diksic

Research output: Contribution to journalArticlepeer-review

66 Scopus citations

Abstract

Epilepsy surgery has been successfully performed in patients with tuberous sclerosis complex (TSC) and seizures arising from a restricted epileptogenic area. The outcome of cortical excision depends on accurate pre-surgical identification of the epileptogenic tuber. [11C] α-methyl-L-tryptophan (α-MTrp) was originally developed to measure serotonin synthesis in vivo with positron emission tomography (PET). However in pathologic conditions its uptake may also depend on the synthesis of quinolinic or kynurenic acid via the kynurenine pathway. Increased levels of serotonin and quinolinic acid have been observed in epileptogenic lesions, raising the possibility that α-MTrp PET may localize the epileptogenic area. The aim of this study was to correlate α-MTrp PET uptake with the localization of the epileptogenic area and with interictal spike frequency in patients with TSC. α-MTrp uptake was measured in 8 patients (2 males, mean age 29.6±14.9 years, range 3-50 years) with intractable partial epilepsy due to TSC. All patients underwent scalp EEG monitoring during the PET scan. In four (50%), increased uptake of α-MTrp occurred in the epileptogenic area alone. Two (25%) patients showed multifocal abnormalities and the remaining two (25%) did not show focal changes. PET localization was mostly seen in patients with frequent interictal abnormalities on the EEG. Furthermore, there was a significant correlation between α-MTrp uptake and the frequency of interictal spikes (r=0.6; P<0.05). α-MTrp PET is a promising diagnostic tool in the localization of the epileptogenic area in patients with TSC.

Original languageEnglish (US)
Pages (from-to)203-213
Number of pages11
JournalEpilepsy Research
Volume52
Issue number3
DOIs
StatePublished - Jan 2003
Externally publishedYes

Keywords

  • Epilepsy
  • Imaging
  • PET
  • Tuberous sclerosis complex

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Fingerprint Dive into the research topics of 'α-[<sup>11</sup>C]-methyl-L-tryptophan PET identifies the epileptogenic tuber and correlates with interictal spike frequency'. Together they form a unique fingerprint.

Cite this