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Network Analysis of the Default Mode Network Using Functional Connectivity MRI in Temporal Lobe Epilepsy
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Proton MR Spectroscopy in Patients with Structural MRI-Negative Temporal Lobe Epilepsy.

Michael Y Xu1, Erhan Ergene1, Michael Zagardo2

  • 1Department of Neurology, Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL.

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|May 27, 2015
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Summary

Magnetic resonance spectroscopy (MRS) can help identify the seizure focus in temporal lobe epilepsy (TLE) patients with normal MRI scans. Reduced N-acetylaspartate (NAA) ratios in the affected hippocampus aid in localizing the epileptogenic zone.

Keywords:
MR spectroscopyMRItemporal lobe epilepsy

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Area of Science:

  • Neuroimaging
  • Epilepsy Research
  • Biochemical Markers

Background:

  • Conventional MRI fails to identify pathology in 20-30% of temporal lobe epilepsy (TLE) cases.
  • Further investigation is needed to refine pre-surgical evaluation and understand epilepsy mechanisms.
  • Magnetic resonance spectroscopy (MRS) offers potential for detecting subtle abnormalities.

Purpose of the Study:

  • To compare hippocampal N-acetylaspartate (NAA), creatine (Cr), and choline (Cho) levels in MRI-negative TLE patients and healthy controls.
  • To assess the utility of MRS in identifying the epileptogenic zone in TLE.
  • To evaluate the correlation between MRS findings and surgical outcomes.

Main Methods:

  • MRS was performed on 20 MRI-negative TLE patients and 10 healthy controls.
  • Concentrations of NAA, Cr, Cho, and their ratios (NAA/Cr, NAA/(Cr+Cho)) were measured in hippocampi.
  • Seven TLE patients underwent surgery; pathological results and outcomes were analyzed.

Main Results:

  • Significantly decreased NAA/Cr and NAA/(Cr+Cho) ratios were observed in the hippocampi ipsilateral to the seizure focus in TLE patients compared to controls and contralateral hippocampi.
  • No significant differences were found between contralateral hippocampi and control hippocampi.
  • Pathology revealed mild-to-moderate gliosis and minimal neuronal loss; 5 patients achieved seizure freedom post-surgery.

Conclusions:

  • Reduced NAA/Cr and NAA/(Cr+Cho) ratios in the affected hippocampus can help lateralize and localize the epileptogenic zone in MRI-negative TLE.
  • MRS may reduce the need for invasive intracranial EEG monitoring.
  • MRS findings correlate with surgical outcomes in TLE.