PROTON NMR SPECTROSCOPY OF HUMAN FOCAL EPILEPSY AT 4 1 T

人类局灶性癫痫在 4·1 T 下的质子核磁共振波谱

• 批准号: 2609677
• 负责人: RUBEN I KUZNIECKY
• 金额: $ 19.39万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 1995
• 资助国家: 美国
• 起止时间: 1995-12-15 至 1999-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2609677
• 关键词: aspartate; brain disorder diagnosis; brain metabolism; cell death; clinical research; creatine; diagnosis design /evaluation; epilepsy; human subject; noninvasive diagnosis; nuclear magnetic resonance spectroscopy; partial seizure; positron emission tomography

DESCRIPTION: (Applicant's Abstract) Intractable epilepsy often beginning in childhood affects approximately 250,000 people in the United States despite optimal medical therapy. Surgical treatment of epilepsy is an effective procedure in selected patients. However, despite being highly effective, fewer than 600 patients are surgically treated in the U.S. each year. Presurgical investigations in candidates include scalp EEG, MRI, PET and intracranial EEG studies in some patients. However the sensitivity of scalp EEG is approximately 50 percent and that of PET and MRI approximately 70 percent in patients with partial seizures. This indicates that other noninvasive and highly sensitive localizing tests are needed. Recent technological advances in particular magnetic resonance spectroscopy (MRS) has been shown to noninvasively detect metabolic abnormalities in the epileptogenic focus. Preliminary experience with single voxel proton MRS suggests N-acetylaspartate (NAA) and creatine (Cr) ratio abnormalities in the site of the epileptic focus. Our recent experience using proton MR spectroscopic imaging suggest a 100 percent sensitivity and indicates bilateral metabolic abnormalities when other techniques indicated unilateral changes. The reasons for the metabolic changes are unclear but it has been postulated that they are related to neuronal cell loss. We propose to investigate the sensitivity and specificity of proton MRS in 150 patients with partial seizures of temporal and extratemporal lobe origin. Comparisons with neuronal cell loss by quantitative analysis of tissue resected at surgery and correlations with in vitro MRS studies will be carried out to permit a rational explanation of the findings detected by in vivo proton MRS. In addition the sensitivity and specificity of this technique will be compared to other methods including EEG, PET, and MRI. Finally the prognostic significance of the proton NMR based abnormalities will be studied through correlations with the surgical outcome. The availability of a 4.1T MR instrument providing improved sensitivity and small voxel size permits the construction of spectroscopic images based on these metabolic ratios. These maps may permit accurate localization of the epileptogenic focus in patients with partial seizures and may allow the noninvasive selection of patients for surgery. This in turn may allow cost effective interventions and may increase the number of surgeries with the consequent socioeconomic gains.

描述：（申请人的摘要）难治性癫痫通常开始于 在美国，大约有25万人在童年时患上了这种疾病。 尽管有最佳的药物治疗癫痫的治疗方法有哪些？ 在选定的患者中进行有效治疗。然而，尽管高度 在美国，只有不到600名患者接受了手术治疗。 每年.术前检查包括头皮脑电图， 部分患者进行MRI、PET和颅内EEG检查。然而 头皮EEG的灵敏度约为50%，PET和 部分性癫痫患者的MRI检查约占70%。这 表明其他非侵入性和高灵敏度的定位测试 是必要的。最新技术进展，特别是磁性材料 共振波谱（MRS）已被证明可以非侵入性地检测 癫痫病灶的代谢异常初步 单体素质子MRS经验提示N-乙酰天冬氨酸（NAA） 和肌酸（Cr）比值异常的癫痫部位 专心点我们最近使用质子磁共振波谱成像的经验 表明100%的敏感性，并表明双侧代谢 当其他技术表明单侧变化时，异常。的 代谢变化的原因尚不清楚，但据推测， 它们与神经元细胞丢失有关。我们建议调查 150例脑梗死患者质子磁共振波谱敏感性和特异性 颞叶和颞外叶起源的部分性癫痫发作。比较 通过定量分析切除的组织， 将进行手术和与体外MRS研究的相关性 为了合理解释体内检测到的结果， 质子核磁共振。此外，该方法的灵敏度和特异性 技术将与其他方法进行比较，包括EEG，PET和MRI。 最后，基于质子核磁共振的异常的预后意义 将通过与手术结果的相关性进行研究。的 4.1T MR仪器的可用性，可提高灵敏度， 小的体素尺寸允许基于 对这些代谢率的影响。这些地图可以允许精确定位 部分性癫痫患者的致痫灶， 允许无创选择患者进行手术。这反过来 可能允许成本有效的干预措施，并可能增加 手术带来的社会经济效益。