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- Title
Identification of Abnormal Neuronal Metabolism Outside the Seizure Focus in Temporal Lobe Epilepsy.
- Authors
Mueller, Suzanne G.; Laxer, Kenneth D.; Cashdollar, Nathan; Flenniken, Derek L.; Matson, Gerald B.; Weiner, Michael W.
- Abstract
Purpose: The aim of this study was to identify metabolically abnormal extrahippocampal brain regions in patients with temporal lobe epilepsy with (TLE-MTS) and without (TLE-no) magnetic resonance imaging (MRI) evidence for mesial-temporal sclerosis (MTS) and to assess their value for focus lateralization by using multislice 1H magnetic resonance spectroscopic imaging (MRSI). Methods: MRSI in combination with tissue segmentation was performed on 14 TLE-MTS and seven TLE-no and 12 age-matched controls. In controls, N-acetylaspartate/(creatine + choline) [NAA/(Cr+Cho)] of all voxels of a given lobe was expressed as a function of white matter content to determine the 95% prediction interval for any additional voxel of a given tissue composition. Voxels with NAA/(Cr+Cho) below the lower limit of the 95% prediction interval were defined as “pathological” in patients and controls. Z-scores were used to identify regions with a higher percentage of pathological voxels than those in controls. Results: Reduced NAA/(Cr+Cho) was found in ipsilateral temporal and parietal lobes and bilaterally in insula and frontal lobes. Temporal abnormalities identified the epileptogenic focus in 70% in TLE-MTS and 83% of TLE-no. Extratemporal abnormalities identified the epileptogenic focus in 78% of TLE-MTS but in only 17% of TLE-no. Conclusions: TLE is associated with extrahippocampal reductions of NAA/(Cr+Cho) in several lobes consistent with those brain areas involved in seizure spread. Temporal and extratemporal NAA/(Cr+Cho) reductions might be helpful for focus lateralization.
- Subjects
BRAIN diseases; EPILEPSY; DEVELOPMENTAL disabilities; MEDICAL imaging systems; MAGNETIC resonance imaging; CEREBRAL dominance
- Publication
Epilepsia (Series 4), 2004, Vol 45, Issue 4, p355
- ISSN
0013-9580
- Publication type
Article
- DOI
10.1111/j.0013-9580.2004.27603.x