α-[11C]-Methyl-L-tryptophan-PET in 191 patients with tuberous sclerosis complex

Harry T. Chugani, Aimee F. Luat, Ajay Kumar, Rajkumar Govindan, Kathy Pawlik, Eishi Asano

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55 Scopus citations

Abstract

Objectives: This was an observational study done on a large cohort of patients with tuberous sclerosis complex (TSC) to determine whether i) the presence of a-[11C]-methyl-L-tryptophan (AMT) hotspots is related to the duration of seizure intractability, ii) the presence of AMT hotspots is related to specific TSC gene mutations, and iii) there is concordance between areas with an AMT hotspot and seizure lateralization/localization on scalp EEG. Methods: One hundred ninety-one patients (mean age: 6.7 years; median: 5 years; range: 3 months to 37 years) with TSC and intractable epilepsy were included. All patients underwent AMT-PET scan. AMT uptake in each tuber and normal-appearing cortex was measured and correlated with clinical, scalp EEG, and, if available, electrocorticographic data. Results: The longer the duration of seizure intractability, the greater the number of AMThotspots (r5 0.2; p 5 0.03). AMT hotspots were seen in both TSC1 and TSC2. There was excellent agreement in seizure focus lateralization between ictal scalp EEG and AMT-PET (Cohen κ 0.94) in 68 of 95 patients in whom both ictal video-EEG and AMT-PET showed lateralizing findings; in 28 of 68 patients (41%),AMT wasmore localizing. Furthermore,AMT-PETwas localizing in 10 of 17 patients (58%) with nonlateralized ictal EEG. Conclusion: AMT-PET, when used together with video-EEG, provides additional lateralization/ localization data, regardless of TSC mutation. The duration of seizure intractability may predict the multiplicity of areas with AMT hotspots.

Original languageEnglish
Pages (from-to)674-680
Number of pages7
JournalNeurology
Volume81
Issue number7
DOIs
StatePublished - Aug 13 2013

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