Proton MR spectroscopy in patients with seizure disorders

• Published in: American journal of neuroradiology : AJNR Vol. 15; no. 2; pp. 373 - 384
• Main Authors: Breiter, SN, Arroyo, S, Mathews, VP, Lesser, RP, Bryan, RN, Barker, PB
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.02.1994; American Society of Neuroradiology
• Subjects: Adolescent; Adult; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Biological and medical sciences; Brain - metabolism; Cerebral Cortex - metabolism; Child; Child, Preschool; Choline - metabolism; Creatine - metabolism; Dominance, Cerebral - physiology; Energy Metabolism - physiology; Epilepsy - diagnosis; Epilepsy - physiopathology; Epilepsy, Temporal Lobe - diagnosis; Epilepsy, Temporal Lobe - physiopathology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Infant; Lactates - metabolism; Lactic Acid; Magnetic Resonance Spectroscopy - methods; Male; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Reference Values; Research Support, Non-U.S. Gov't; Temporal Lobe - metabolism; Human; Nervous system diseases; Epilepsy; Central nervous system disease; Exploration; NMR spectrometry; Diagnosis; Cerebral disorder; Brain (vertebrata)
• ISSN: 0195-6108; 1936-959X

To evaluate the ability of proton MR spectroscopy to detect metabolic abnormalities in the seizure focus of humans with epilepsy. Single-voxel MR spectroscopy and MR imaging was performed in a group of 13 patients with a variety of seizure disorders and in the temporal lobes of 14 healthy volunteers. Signals from choline, creatine, N-acetyl-L-aspartate, and lactate were quantitated in both the epileptogenic focus and the contralateral brain region. In normal temporal lobe, concentrations of choline, creatine, and N-acetyl-L-aspartate were 2.0 +/- 0.7, 7.8 +/- 1.9, and 11.0 +/- 2.1 mumol/g wet weight, respectively, with no detectable lactate. In all patients, a reduction in the N-acetyl-L-aspartate signal was observed in the electrically defined (scalp electroencephalogram) seizure focus compared with the mirror-image contralateral side. Lactate was elevated only in patients who had seizures during or immediately before the MR examination. Seven of 13 patients studied had normal MR examinations. Proton spectroscopy demonstrates alterations in N-acetyl-L-aspartate and lactate levels that can be used to locate the epileptogenic focus and may be a useful adjunctive diagnostic technique for the evaluation of patients with seizures who are eligible for resective surgery.