Metabolic abnormalities in mesial temporal lobe epilepsy patients depicted by proton MR spectroscopy using a 3. 0t MR scanner.
OBJECTIVE
To evaluate metabolic abnormalities in patients with mesial temporal lobe epilepsy (MTLE) with proton magnetic resonance spectroscopy (MRS) using a 3. 0T MR scanner.


METHODS
Sixty-three patients (32 women and 31 men) with diagnosed MTLE underwent diagnostic MR imaging (MRI) and proton MRS using a 3. 0T MR scanner. The clinical history and interictal epileptiform discharges (IEDs) were recorded. Sixteen healthy volunteers served as control. The results of proton MRS were compared with the findings of electroencephalogram and structural MRI findings.


RESULTS
Twenty-seven of the 63 patients with MTLE showed unilateral hippocampal sclerosis, and 9 showed bilateral hippocampal sclerosis. The concentration ratio of N-acytelaspartate (NAA)/[creatine (Cr) + choline (Cho)] in the hippocampal region of MTLE patients (0.64 +/- 0.07) was significantly lower than control (0.80 +/- 0.05, P = 0.023). In the patients with unilateral hippocampal sclerosis, NAA/(Cr + Cho) in the hippocampal region ipsilateral to the sclerotic hippocampus (0.56 +/- 0.06) was significantly lower than the ratio in the contralateral hippocampal region (0.69 +/- 0.07, P < 0.001). There was significant difference in hippocampal NAA/(Cr + Cho) between the refractory patients and the non-refractory patients (0.64 +/- 0.05 vs. 0.71 +/- 0.07, P = 0.04). Forty-five patients were lateralized by IEDs, while 49 patients were lateralized by metabolite ratio. And lateralization determined by proton MRS and IEDs was concordant in 33 patients.


CONCLUSIONS
MRS as a noninvasive tool adds helpful metabolite information to routine MRI in evaluation of MTLE. The method is well established and should be a routine clinical application in the investigation of epilepsy.
Lu
Jing-Jing
JJ
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730.
Ren
Lian-Kun
LK
Feng
Feng
F
You
Hui
H
Zhang
Li-Hua
LH
Li
Ming-Li
ML
Sun
Fei
F
Fu
Hai-Hong
HH
Jin
Zheng-Yu
ZY
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000378:metabolism*; D005260:Female; D006624:Hippocampus / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000295:instrumentation / Q000379:methods; D008297:Male; D011522:Protons
D011522:Protons; D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline