Reduction in temporal N-acetylaspartate and creatine (or choline) ratio in temporal lobe epilepsy: does this 1H-magnetic resonance spectroscopy finding mean poor seizure control?
Reduction in temporal N-acetylaspartate and creatine (or choline) ratio in temporal lobe epilepsy: does this 1H-magnetic resonance spectroscopy finding mean poor seizure control?
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颞叶癫痫中颞叶 N-乙酰天冬氨酸和肌酸（或胆碱）比率降低：1H 磁共振波谱发现是否意味着癫痫控制不佳？
DOI：
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发表时间：
1998
影响因子：
11
通讯作者：
M. Guimarães
中科院分区：
文献类型：
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作者：
J. Mendes;Raquel Soares;F. Simões;M. Guimarães
背景质子磁共振波谱（1H-MRS）是研究难治性颞叶癫痫（TLE）患者体内脑代谢物的潜在有用工具。局灶n -乙酰天冬氨酸（NAA）减少与手术切除的癫痫灶中内侧颞叶硬化（MTS）相关。目的探讨难治性颞叶癫痫患者、无发作颞叶癫痫患者及正常人颞叶代谢产物NAA、肌酸+磷酸肌酸（Cr）、含胆碱化合物（Cho）的异常情况。患者与方法采用h -磁共振波谱技术对10例难治性颞叶癫痫患者、12例无发作的颞叶癫痫患者和10例年龄匹配的正常人进行研究。所有患者均有持续的单侧颞叶脑电图异常和正常的脑MRI。在颞叶癫痫患者（与脑电图病灶同侧）和正常对照的内侧颞叶中取8 ml体积的质子磁共振谱。测量的信号以NAA/Cr、NAA/Cho和Cho/Cr表示。结果10例难治性颞叶癫痫患者的NAA/Cr比(1.65 （0.53)v 2.62（0.60）和2.66(0.73)）均低于无发作的颞叶癫痫患者和正常对照；p<0.002和p<0.006)， NAA/Cho比值分别为1.59（0.79）、2.83（1.33）和2.58 (0.67)；p < 0.02 andp < 0.007)。此外，无发作组NAA/Cr比值最低的2例患者（1.47和1.73）既往发作控制较差。结论：颞叶癫痫患者的NAA/Cr和NAA/Cho比值降低，提示神经元丢失或损伤与过去或现在的癫痫控制不良有关，但不排除未来癫痫完全控制的可能性（1H-MRS时无癫痫发作的颞叶癫痫患者）。这项研究需要对更多的颞叶癫痫患者进行进一步的1h - mrs调查。
BACKGROUND Proton magnetic resonance spectroscopy (1H-MRS) is a potentially useful tool in the in vivo investigation of brain metabolites in intractable temporal lobe epilepsy (TLE). Focal N-acetylaspartatate (NAA) reductions have been correlated with mesial temporal sclerosis (MTS) in surgically resected epileptogenic foci. OBJECTIVE To evaluate the abnormalities in the metabolites NAA, creatine+ phosphocreatine (Cr), and choline containing compounds (Cho) in the temporal lobe of medically refractory patients with temporal lobe epilepsy, seizure free patients with temporal lobe epilepsy, and normal controls. PATIENTS AND METHODS Ten refractory patients, 12 seizure free patients with temporal lobe epilepsy, and 10 age matched normal controls were studied by 1H-magnetic resonance spectroscopy. All patients had consistently unilateral temporal EEG abnormalities and a normal brain MRI. Proton MR spectra were obtained from an 8 ml volume in the medial temporal lobes in patients with temporal lobe epilepsy (ipsilateral to EEG foci) and the normal controls. The signals measured were expressed in terms of NAA/Cr, NAA/Cho, and Cho/Cr. RESULTS When compared with seizure free patients with temporal lobe epilepsy and normal controls, the 10 refractory patients with temporal lobe epilepsy had a lower mean (SEM) NAA/Cr ratio (1.65 (0.53) v 2.62 (0.60), and 2.66 (0.73); p<0.002 and p<0.006) and a lower mean NAA/Cho ratio (1.59 (0.79)v 2.83 (1.33) and 2.58 (0.67); p<0.02 andp<0.007). Furthermore, the two patients showing the lowest NAA/Cr ratios (1.47 and 1.73) in the seizure free group had had a past period of poor seizure control. CONCLUSIONS There were reduced temporal NAA/Cr and NAA/Cho ratios, suggesting neuronal loss or damage, associated with past or present poor seizure control in the patients with temporal lobe epilepsy, but it does not exclude the possibility of a future complete seizure control (seizure free patients with temporal lobe epilepsy at the time of 1H-MRS). This study warrants further1H-MRS investigation with a larger series of patients with temporal lobe epilepsy.