Temporal lobe magnetic resonance spectroscopic imaging following selective amygdalohippocampectomy for treatment-resistant epilepsy.
OBJECTIVE
Magnetic resonance spectroscopic imaging (MRSI) may show circumscribed or extensive decreased brain N-acetyl aspartate (NAA)/creatine and phosphocreatine (Cr) in epilepsy patients. We compared temporal lobe MRSI in patients seizure-free (SzF) or with persistent seizures (PSz) following selective amygdalohippocampectomy (SAH) for medically intractable mesial temporal lobe epilepsy (mTLE). We hypothesized that PSz patients had more extensive temporal lobe metabolite abnormalities than SzF patients.


METHODS
MRSI was used to study six regions of interest (ROI) in the bilateral medial and lateral temporal lobes in 14 mTLE patients following SAH and 11 controls.


RESULTS
PSz patients had more temporal lobe ROI with abnormally low NAA/Cr than SzF patients, including the unoperated hippocampus and ipsilateral lateral temporal lobe.


CONCLUSIONS
Postoperative temporal lobe MRSI abnormalities are more extensive if surgical outcome following SAH is poor. MRSI may be a useful tool to improve selection of appropriate candidates for SAH by identifying patients requiring more intensive investigation prior to epilepsy surgery. Future prospective studies are needed to evaluate the utility of MRSI, a predictor of successful outcome following SAH.
Spencer
D C
DC
Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA. spencerd@ohsu.edu
Szumowski
J
J
Kraemer
D F
DF
Wang
P Y
PY
Burchiel
K J
KJ
Spielman
D M
DM
D000328:Adult; D000679:Amygdala / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000032:analysis / Q000378:metabolism; D001923:Brain Chemistry / Q000502:physiology*; D003401:Creatine / Q000032:analysis / Q000378:metabolism; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000378:metabolism* / Q000601:surgery; D005260:Female; D006624:Hippocampus / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000378:metabolism / Q000503:physiopathology; D019635:Neurosurgical Procedures; D010725:Phosphocreatine / Q000032:analysis / Q000378:metabolism; D011237:Predictive Value of Tests; D012016:Reference Values; D016896:Treatment Outcome
D010725:Phosphocreatine; D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine