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Metabolic characteristics of cortical malformations causing epilepsy
S G Mueller1, K D Laxer, J A Barakos
1Dept. of Veterans Affairs (DVA), Medical Center, Magnetic Resonance Spectroscopy Unit, San Francisco, CA 94115, USA.
Journal of Neurology
|May 4, 2005
Summary
Cortical malformations (CMs) in epilepsy patients show metabolic heterogeneity. The surrounding brain tissue (perilesional zone) also exhibits metabolic abnormalities, suggesting potential microscopic malformations and epileptogenicity.
Area of Science:
- Neuroimaging
- Epileptology
- Metabolic Brain Research
Background:
- Cortical malformations (CMs) are increasingly identified as a key cause of drug-resistant neocortical epilepsy (NE).
- Understanding the metabolic profile of CMs and adjacent brain regions is crucial for diagnosing and treating NE.
Purpose of the Study:
- To investigate the metabolic heterogeneity within CMs.
- To determine if the perilesional zone in NE patients exhibits similar metabolic abnormalities as the CMs.
Main Methods:
- Magnetic resonance spectroscopic imaging (MRSI) combined with tissue segmentation was used.
- Metabolic thresholds were established in 19 healthy controls.
- These thresholds identified abnormal voxels within CMs and perilesional zones in 8 NE patients.
Main Results:
- 30% of voxels within CMs displayed abnormalities, primarily decreased N-acetylaspartate (NAA) or increased choline (Cho).
- Abnormalities in CMs formed heterogeneous clusters.
- 15% of perilesional voxels were abnormal, often showing decreased NAA and creatine (Cr).
Conclusions:
- CMs contain metabolically heterogeneous abnormal regions interspersed with normal tissue.
- Perilesional metabolic abnormalities share characteristics with CMs, indicating potential microscopic malformations.
- These findings suggest the perilesional zone may contribute to the intrinsic epileptogenicity in NE.