Widespread extrahippocampal NAA/(Cr+Cho) abnormalities in TLE with and without mesial temporal sclerosis.
MR spectroscopy has demonstrated extrahippocampal NAA/(Cr+Cho) reductions in medial temporal lobe epilepsy with (TLE-MTS) and without (TLE-no) mesial temporal sclerosis. Because of the limited brain coverage of those previous studies, it was, however, not possible to assess differences in the distribution and extent of these abnormalities between TLE-MTS and TLE-no. This study used a 3D whole brain echoplanar spectroscopic imaging (EPSI) sequence to address the following questions: (1) Do TLE-MTS and TLE-no differ regarding severity and distribution of extrahippocampal NAA/(Cr+Cho) reductions? (2) Do extrahippocampal NAA/(Cr+Cho) reductions provide additional information for focus lateralization? Forty-three subjects (12 TLE-MTS, 13 TLE-no, 18 controls) were studied with 3D EPSI. Statistical parametric mapping (SPM2) was used to identify regions of significantly decreased NAA/(Cr+Cho) in TLE groups and in individual patients. TLE-MTS and TLE-no had widespread extrahippocampal NAA/(Cr+Cho) reductions. NAA/(Cr+Cho) reductions had a bilateral fronto-temporal distribution in TLE-MTS and a more diffuse, less well defined distribution in TLE-no. Extrahippocampal NAA/(Cr+Cho) decreases in the single subject analysis showed a large inter-individual variability and did not provide additional focus lateralizing information. Extrahippocampal NAA/(Cr+Cho) reductions in TLE-MTS and TLE-no are neither focal nor homogeneous. This reduces their value for focus lateralization and suggests a heterogeneous etiology of extrahippocampal spectroscopic metabolic abnormalities in TLE.
Center for Imaging of Neurodegenerative Diseases and Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. susanne.mueller@ucsf.edu
Susanne G
SG
Mueller
Andreas
A
Ebel
Jerome
J
Barakos
Cathy
C
Scanlon
Ian
I
Cheong
Daniel
D
Finlay
Paul
P
Garcia
Michael W
MW
Weiner
Kenneth D
KD
Laxer
D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001931:Brain Mapping; D002794:Choline / Q000378:metabolism*; D003401:Creatine / Q000378:metabolism*; D004833:Epilepsy, Temporal Lobe / Q000150:complications*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012598:Sclerosis / Q000209:etiology; D013702:Temporal Lobe / Q000473:pathology*; D055815:Young Adult
D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline