Reduction in temporal N-acetylaspartate and creatine (or choline) ratio in temporal lobe epilepsy: does this H-1-magnetic resonance spectroscopy finding mean poor seizure control?

• Type: Article in International Scientific Journal
• Date: 1998

Authors

mendes-ribeiro, ja (Author) Other; soares, r (Author) FMDUP; simoes-ribeiro, f (Author) Other; guimaraes, ml (Author) Other

Journal

Title: Journal of Neurology, Neurosurgery and Psychiatry

Vol. 65

Pages: 518-522

ISSN: 0022-3050

Publisher: BMJ PUBLISHING GROUP

Indexing

ISI Web of Knowledge - 21 Citations

Scopus - 25 Citations

Other information

Authenticus ID: P-001-717

DOI: 10.1136/jnnp.65.4.518

Abstract (EN): Background-Proton magnetic resonance spectroscopy (H-1-MRS) is a potentially useful tool in the in vivo investigation of brain metabolites in intractable temporal lobe epilepsy (TLE). Focal N-acetylaspartatate (NAA) reductions have been correlated with mesial temporal sclerosis (MTS) in surgically resected epileptogenic foci. Objective-To evaluate the abnormalities in the metabolites NAA, creatine+ phosphocreatine (Cr), and choline containing compounds (Cho) in the temporal lobe of medically refractory patients with temporal lobe epilepsy, seizure free patients with temporal lobe epilepsy, and normal controls. Patients and methods-Ten refractory patients, 12 seizure free patients with temporal lobe epilepsy, and 10 age matched normal controls were studied by H-1-magnetic resonance spectroscopy. All patients had consistently unilateral temporal EEG abnormalities and a normal brain MRI. Proton MR spectra were obtained from an 8 mi volume in the medial temporal lobes in patients with temporal lobe epilepsy (ipsilateral to EEG foci) and the normal controls. The signals measured were expressed in terms of NAA/Cr, NAA/Cho, and Cho/Cr. Results-When compared with seizure free patients with temporal lobe epilepsy and normal controls, the 10 refractory patients with temporal lobe epilepsy had a lower mean (SEM) NAA/Cr ratio (1.65 (0.53) v 2.62 (0.60), and 2.66 (0.73); p<0.002 and p<0.006) and a lower mean NAA/Cho ratio (1.59 (0.79) v 2.83 (1.33) and 2.58 (0.67); p<0.02 and p<0.007). Furthermore, the two patients showing the lowest NAA/Cr ratios (1.47 and 1.73) in the seizure free group had had a past period of poor seizure control. Conclusions-There were reduced temporal NAA/Cr and NAA/Cho ratios, suggesting neuronal loss or damage, associated with past or present poor:seizure control in the patients with temporal lobe epilepsy, but it does not exclude the possibility of a future complete seizure control (seizure free patients with temporal lobe epilepsy at the time of H-1-MRS). This study warrants further H-1-MRS investigation with a larger series of patients with temporal lobe epilepsy.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 5