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a Neurophysiology Unit, b Department of Neurology and
Neurosurgery, Hospital S João, Porto, Portugal, c Magnetic Resonance Unit, IPO, Porto,
Portugal
Correspondence to: Dr José A Mendes-Ribeiro, Rua 5 de Outubro, 765, Gueifães, 4470 Maia, Portugal.
Received 18 November 1997 and in revised form 11 February 1998;
Accepted 19 March 1998
BACKGROUND
Proton magnetic resonance spectroscopy
(1H-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.
OBJECTIVETo 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 METHODSTen refractory patients, 12 seizure free patients with temporal lobe epilepsy, and 10 age matched
normal controls were studied by 1H-magnetic resonance
spectroscopy. All patients had consistently unilateral temporal EEG
abnormalities and a normal brain MRI. Proton MR spectra were obtained
from an 8 ml 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.
RESULTSWhen 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 andp<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.
CONCLUSIONSThere 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 1H-MRS). This study warrants further
1H-MRS investigation with a larger series of patients with
temporal lobe epilepsy.
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 W. G. Bradley and R. B. Shey MR Imaging Evaluation of Seizures Radiology, March 1, 2000; 214(3): 651 - 656. [Abstract] [Full Text]
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