Spatial extent of neuronal metabolic dysfunction measured by proton MR spectroscopic imaging in patients with localization-related epilepsy
Spatial extent of neuronal metabolic dysfunction measured by proton MR spectroscopic imaging in patients with localization-related epilepsy
复制标题
DOI：
10.1111/j.1528-1157.2000.tb00226.x
复制
发表时间：
2000-06-01
期刊：
影响因子：
5.6
通讯作者：
Arnold, DL
中科院分区：
文献类型：
--
作者：
Li, LM;Cendes, F;Arnold, DL
目的：为了评估的空间范围内的神经元标记物N-乙酰天冬氨酸（NAA）相对于肌酸（Cr）的患者与本地化相关的癫痫减少，并评估患者之间的临床差异，并没有广泛的NAA/Cr reduction.Methods：我们研究了51例本地化相关的癫痫。根据EEG检查将患者分为三组：（a）颞叶癫痫（TLE，n = 21），（B）颞叶外癫痫（extra-TLE，n = 20）和（c）多叶癫痫（致痫区较宽的患者，n = 10）。我们获得质子磁共振（MR）光谱成像（H-1-MRSI）的颞叶和额顶区在单独的检查患者和对照组。结果：23例（45%）TLE患者（12例）的MRI表现正常，包括海马体积改变。49例（96%）患者NAA/Cr较低，表明颞叶和/或颞外H-1-MRSIs神经元功能障碍; 38%的TLE患者和50%的TLE外患者在临床和EEG定义的原发性癫痫区域外也有NAA/Cr降低。NAA/Cr降低在多叶组[6/10]比颞叶或颞外组[5/16]更常见。（a）癫痫发作持续时间，（B）癫痫发作频率和（c）估计的癫痫发作寿命的非参数检验显示无统计学显著性差异（p > 0.05）对于发作病灶外有或没有NAA/Cr降低的TLE和额外TLE患者。在定位相关性癫痫患者中，40-50%的患者具有神经元代谢功能障碍，其超出临床EEG定义的致痫区和/或MRI定义的结构异常。
Purpose: To assess the spatial extent of the decrease in the neuronal marker N-acetyl-aspartate (NAA) relative to creatine (Cr) in patients with localization-related epilepsy, and to assess clinical differences between patients with and without widespread NAA/Cr reduction.Methods: We studied 51 patients with localization-related epilepsy. Patients were divided into three groups according to the EEG investigation: (a) temporal lobe epilepsy (TLE, n = 21), (b) extratemporal lobe epilepsy (extra-TLE, n = 20), and (c) multilobar epilepsy (patients with a wider epileptogenic zone, n = 10). We acquired proton magnetic resonance (MR) spectrocopic imaging (H-1-MRSI) of temporal and frontocentroparietal regions in separate examinations for both patients and controls. NAA/Cr values 2 standard deviations below the mean of normal controls were considered abnormal.Results: Twenty-three (45%) patients including 12 with TLE had normal MR imaging including volumetric studies of the hippocampus. Forty-nine (96%) patients had low NAA/Cr, indicating neuronal dysfunction in either temporal and/or extratemporal H-1-MRSIs; 38% of patients with TLE and 50% of patients with extra-TLE also had NAA/Cr reduction outside the clinical and EEG-defined primary epileptogenic area. The NAA/Cr reduction was more often widespread in the multilobar group [six (60%) of 10] than in temporal or extratemporal groups [five (31%) of 16]. Nonparametric tests of (a) seizure duration, (b) seizure frequency, and (c) lifetime estimated seizures showed no statistically significant difference (p > 0.05) for TLE and extra-TLE patients with or without NAA/Cr reduction outside the seizure focus.Conclusions: Of patients with localization-related epilepsy, 40-50% have neuronal metabolic dysfunction that extends beyond the epileptogenic zone defined by clinical-EEG and/or the structural abnormality defined by MRI.