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1H MR spectroscopy in patients with mesial temporal epilepsy
M Hájek1, M Dezortová, V Komárek
1Magnetic Resonance Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. miha@medicon.cz
Abstract:
The study provides a review of the basic examination procedures and results of proton magnetic resonance spectroscopy (1H MRS) in patients suffering from mesial temporal lobe epilepsy (MTLE). The source of seizures in MTLE is most often an epileptogenic focus secondary to hippocampal sclerosis. 1H MRS currently plays an important role in the non-invasive diagnosis of this type of epileptogenic lesion. The decisive 1H MRS parameter characterizing an epileptogenic lesion is a statistically significantly decreased value of N-acetylaspartate levels compared with control values, most often associated with a decrease in the ratios of the intensities of NAA/Cr, NAA/Cho and NAA/(Cr + Cho) signals. Moreover, MRS makes it possible to distinguish bilateral involvement of mesial temporal structures typically associated with a bilateral decrease in the levels of metabolites and/or their ratios. As regards other metabolic compounds which play an important role in the pathobiochemistry of epilepsy, MRS is employed to study the action of gamma-aminobutyric acid (GABA), inositol, lactate, glutamine, and glutamate, the clinical function of which has not been fully clarified as yet. It is in this context that one should consider the application of 1H MRS in evaluating the action of some new anti-epileptic agents affecting excitatory and inhibitory amino acids. There is no doubt that in vivo 1H MRS, along with other imaging methods, has made a significant contribution to the clinical and biochemical description of epileptic seizures and has assumed a prominent position among the techniques of pre-operative examination in epileptic surgery.
Insights
Proton magnetic resonance spectroscopy (1H MRS) is crucial for diagnosing mesial temporal lobe epilepsy (MTLE) by detecting decreased N-acetylaspartate levels. This non-invasive technique aids in identifying epileptogenic lesions and evaluating new anti-epileptic drugs.
Area of Science:
- Neurology
- Medical Imaging
- Biochemistry
Background:
- Mesial temporal lobe epilepsy (MTLE) often originates from hippocampal sclerosis.
- Non-invasive diagnosis of epileptogenic lesions is critical for patient management.
Purpose of the Study:
- To review proton magnetic resonance spectroscopy (1H MRS) procedures and findings in MTLE.
- To highlight the role of 1H MRS in diagnosing MTLE and guiding epilepsy surgery.
Main Methods:
- Review of basic examination procedures and results of 1H MRS in MTLE patients.
- Analysis of metabolite levels (N-acetylaspartate, NAA/Cr, NAA/Cho) and other compounds (GABA, inositol, lactate, glutamine, glutamate).
Main Results:
- Significantly decreased N-acetylaspartate levels and related ratios (NAA/Cr, NAA/Cho) characterize epileptogenic lesions in MTLE.
- 1H MRS can detect bilateral involvement of mesial temporal structures.
- MRS facilitates the study of various metabolites involved in epilepsy pathochemistry.
Conclusions:
- 1H MRS is a valuable non-invasive tool for diagnosing MTLE and identifying epileptogenic lesions.
- 1H MRS aids in evaluating new anti-epileptic agents and contributes to pre-operative assessment for epilepsy surgery.