Role of proton magnetic resonance spectroscopy in preoperative evaluation of patients with mesial temporal lobe epilepsy.
A retrospective study was conducted for evaluation of the role of single-voxel proton magnetic resonance spectroscopy (1H-MRS) in preoperative investigation of patients with mesial temporal lobe epilepsy (MTLE). Eighteen cases, including both non-lesional and lesional MTLE, were analyzed. Selective amygdalohippocampectomy was performed in 8 cases, selective amygdalohippocampectomy combined with lesionectomy in 6 cases, lesionectomy in 3 cases, and anterior temporal lobe resection in one case. The length of follow-up varied from 24 to 71 months (median, 35 months). Before surgery, (1)H-MRS disclosed decrease of N-acetylaspartate (NAA) content (P=0.01) and more frequent (P=0.07) presence of lactate (Lac) on the side of the epileptogenic zone. Decrease of NAA content below 0.75 and/or unilateral presence of Lac provided 86% (95% CI: 68%-100%) lateralization accuracy. Metabolic parameters did not differ in subgroups with hippocampal sclerosis and brain tumors. On the long-term follow-up 12 patients (67%) were free of disabling seizures. There was a trend (P=0.05) for worse seizure outcome in cases with significant bilateral metabolic alterations characterized by predominance of choline-containing compounds' peak on 1H-MR spectra on both sides. In conclusion, 1H-MRS-detected reduction of NAA content and unilateral presence of Lac in the mesial temporal lobe structures may serve as additional diagnostic clues for lateralization of the epileptogenic zone in MTLE. Metabolic imaging has limited usefulness for differentiation of the hippocampal sclerosis and low-grade intraaxial brain tumor. Presence of significant bilateral metabolic alterations in the mesial temporal lobe structures is associated with worse postoperative seizure control.
Chernov
Mikhail F
MF
International Research and Educational Institute for Integrated Medical Sciences (IREIIMS), Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. m_chernov@yahoo.com
Ochiai
Taku
T
Ono
Yuko
Y
Muragaki
Yoshihiro
Y
Yamane
Fumitaka
F
Taira
Takaomi
T
Maruyama
Takashi
T
Tanaka
Masahiko
M
Iseki
Hiroshi
H
Kubo
Osami
O
Okada
Yoshikazu
Y
Hori
Tomokatsu
T
Takakura
Kintomo
K
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism / Q000601:surgery; D001932:Brain Neoplasms / Q000378:metabolism; D004833:Epilepsy, Temporal Lobe / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006624:Hippocampus / Q000378:metabolism / Q000601:surgery; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011522:Protons; D012189:Retrospective Studies; D012598:Sclerosis / Q000378:metabolism / Q000601:surgery; D012640:Seizures / Q000378:metabolism / Q000601:surgery; D055815:Young Adult
D011522:Protons