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Hippocampal region asymmetry assessed by 1H-MRS in rolandic epilepsy
Staffan Lundberg1, Jan Weis, Orvar Eeg-Olofsson
1Department of Women's and Children's Health, Section for Pediatrics, Slovak Academy of Sciences, Bratislava, Slovakia. staffan.lundberg@kbh.uu.se
Insights
Children with rolandic epilepsy (RE) show abnormal hippocampal neuronal function, indicated by altered N-acetylaspartate (tNAA) levels. This magnetic resonance spectroscopy study highlights metabolic changes in the hippocampus of RE patients.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Medical Imaging
Background:
- Rolandic epilepsy (RE) is a common childhood epilepsy syndrome.
- Previous studies indicated hippocampal abnormalities in children with RE using MRI.
- Further investigation into metabolic changes within the hippocampus is warranted.
Purpose of the Study:
- To analyze metabolic changes in the hippocampal region of children with rolandic epilepsy using proton magnetic resonance spectroscopy (1H-MRS).
- To compare hippocampal metabolic profiles between children with RE and healthy controls.
Main Methods:
- Proton magnetic resonance spectroscopy (1H-MRS) was performed on 13 children with RE and 15 healthy controls.
- Voxel placement included the head and body of the hippocampus.
- Metabolite ratios (tNAA/tCr, Glx/tCr, tCho/tCr) and asymmetry indices (AIs) were calculated.
Main Results:
- A significantly higher tNAA/tCr asymmetry index was observed in the hippocampal regions of children with RE compared to controls (p < 0.001).
- No significant differences in Glx/tCr or tCho/tCr asymmetry were found between groups.
- Lateralization of epileptiform activity correlated with lower tNAA/tCr ratios in most RE patients.
Conclusions:
- Altered tNAA/tCr ratios in the hippocampus suggest abnormal neuronal function in children with rolandic epilepsy.
- Hippocampal asymmetry, measured by tNAA/tCr, is a significant finding in RE.
- Findings support the role of hippocampal metabolic alterations in the pathophysiology of RE.
Purpose:
In a previous study, we reported hippocampal abnormalities on magnetic resonance imaging (MRI) in six of 18 children with rolandic epilepsy (RE). In this study, metabolic changes were analyzed in the hippocampal region with proton magnetic resonance spectroscopy (1H-MRS).
Methods:
In 13 children with electroclinically typical RE and 15 healthy controls, 1H-MRS results of both hippocampal regions were analyzed. The voxels, 2 x 2 x 4-cm each, were placed to include the head and body of the hippocampus. A PRESS sequence with TR 2,000 ms and TE 32 ms was used. Total N-acetylaspartate (tNAA), glutamine and glutamate (Glx), and choline compounds (tCho) were related to total creatine (tCr), and asymmetry indices (AIs) were calculated. MRI was performed in all 13 patients and in 13 controls.
Results:
The tNAA/tCr AI of the hippocampal region was significantly higher in children with RE than in control children (z = 4.49; p < 0.001). The AIs of Glx/tCr and tCho/tCr did not show a significant difference between the groups. Lateralization of the interictal epileptiform activity corresponded with the lower tNAA/tCr ratio in 10 of 13 patients. MRI revealed a hippocampal asymmetry in four of 13 in the RE group, three of them showed concordance between the lateralization of the lower tNAA/tCr ratio and the smaller hippocampus. In the control group, a subtle asymmetry in four of 13 children was found.
Conclusions:
A significant asymmetry of the hippocampal regions, measured by tNAA/tCr ratios, indicates an abnormal neuronal function in children with RE.
