1H-MR spectroscopy: a promising method in distinguishing subgroups in temporal lobe epilepsy?

Proton MR spectroscopy offers an additional noninvasive method of supporting focus lateralization in patients with intractable temporal lobe epilepsy. In this study involving 57 patients, the ability of multivoxel 1H-MRS to differentiate between mesial and lateral TLE was investigated in addition to its ability to lateralize the epileptogenic focus. Temporal lobe epilepsy (TLE) was classified into mesiobasal or lateral temporal lobe epilepsy according to the results of preoperative diagnostics including neurological and neuropsychological examinations, video-EEG monitoring and high resolution MRI. 1H-MR-spectroscopy (1H-MRS) showed that pathological changes in the mesial temporal lobes indicate a predominance in different parts of the ipsilateral temporal lobe (hippocampal and parahippocampal areas) correlating to the clinically defined groups. In addition, mesiobasal TLE tends to have higher concomitant contralateral abnormalities. Our results reveal that 1H-MRS is able to distinguish between mesiobasal and lateral pathologies in patients with TLE and represents a useful tool for noninvasive TLE classification.