title: Relation of interictal spike frequency to 1H-MRSI-measured NAA/Cr.
abstract: OBJECTIVE
  Whereas EEG spiking and decreases of the neuronal marker N-acetyl-aspartate (NAA) both localize well the epileptic focus, the significance of the intensity of these variables is unclear. Therefore we investigated whether the frequency of interictal surface spikes is related to the degree of N-acetyl-aspartate/creatine (NAA/Cr) ratio decrease as measured by proton magnetic resonance (MR) spectroscopic imaging (1H-MRSI) in patients with intractable partial epilepsy.
  
  
  METHODS
  We retrospectively studied 14 patients, nine with temporal lobe epilepsy and five with frontal lobe epilepsy. Spikes that occurred during prolonged video-EEG monitoring from electrodes placed according to the International 10-20 system were counted blinded to the 1H-MRSI results. Eight electrode positions (F3/4, C3/4, T3/4, T5/6) were assigned to underlying brain subregions in the 1H-MRSI volume of interest. We converted NAA/Cr ratios into z-scores (NAA/Cr(z)) to compared NAA/Cr values directly across subregions. We calculated Spearman rank-order (p) and Pearson product-moment (r) correlations between spike frequency and NAA/Cr(z) values overall, as well as within each brain subregion.
  
  
  RESULTS
  We found an overall negative relation between spike-frequency data and NAA/Cr(z) data (p = -0.341). When analyzing only spiking subregions, this negative relation became slightly stronger (p = -0.442; r = -0.338). When data from the eight sites were considered separately, this negative relation remained in most instances.
  
  
  CONCLUSIONS
  Our results reveal a trend toward higher interictal spike frequencies on surface EEG in regions of pronounced neuronal metabolic damage or dysfunction. This suggests that both variables parallel an underlying pathologic substrate, although the pathophysiologic processes may be distinct.
authors.affiliation: Department of Neurology and Neurosurgery, McGill University, and Montreal Neurological Institute and Hospital, Quebec, Canada.
authors.forename: W
authors.initials: W
authors.lastname: Serles
authors.forename: L M
authors.initials: LM
authors.lastname: Li
authors.forename: Z
authors.initials: Z
authors.lastname: Caramanos
authors.forename: D L
authors.initials: DL
authors.lastname: Arnold
authors.forename: J
authors.initials: J
authors.lastname: Gotman
mesh_terms: D000293:Adolescent; D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis / Q000378:metabolism; D003401:Creatine / Q000032:analysis* / Q000378:metabolism; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004828:Epilepsies, Partial / Q000175:diagnosis* / Q000378:metabolism; D017034:Epilepsy, Frontal Lobe / Q000175:diagnosis / Q000378:metabolism; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D005625:Frontal Lobe / Q000737:chemistry* / Q000378:metabolism; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000737:chemistry* / Q000378:metabolism
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine