PROTON NMR SPECTROSCOPY OF HUMAN FOCAL EPILEPSY AT 4 1 T

描述：(申请者摘要)顽固性癫痫 在美国大约有25万人在童年时期受到影响 尽管有最佳的治疗方法。癫痫的外科治疗是一种 在选定的患者中进行有效的手术。然而，尽管高度重视 在美国，只有不到600名患者接受了有效的手术治疗。 每年。候选人的手术前检查包括头皮脑电， 部分患者行MRI、PET和颅内EEG检查。然而， 头皮EEG的灵敏度约为50%，而PET和 MRI在部分性癫痫患者中约占70%。这 表明其他非侵入性和高度敏感的定位测试 都是需要的。最近的技术进步，特别是磁学 共振光谱学(MRS)已被证明可以非侵入性地检测 致痫灶的代谢异常。初步 单体素质子磁共振经验提示N-乙酰天冬氨酸(NAA) 癫痫患者发病部位肌酸(Cr)比值异常 全神贯注。我们最近使用质子磁共振波谱成像的经验 建议100%敏感，并表明双侧代谢 当其他技术显示单侧改变时的异常。这个 新陈代谢变化的原因尚不清楚，但已有推测 它们与神经细胞丢失有关。我们建议调查 150例非小细胞肺癌患者质子磁共振波谱检测的敏感性和特异性 起源于颞叶和颞叶外的部分癫痫发作。比较 通过对切除的组织进行定量分析发现神经细胞丢失 将进行手术和与体外MRS的相关性研究。 允许对体内检测到的发现进行合理解释 质子磁共振仪的灵敏度和特异度 这项技术将与包括EEG、PET和MRI在内的其他方法进行比较。 质子核磁共振异常对预后的意义 将通过与手术结果的相关性进行研究。这个 提供4.1T磁共振仪器，提高了灵敏度和 较小的体素大小允许基于 在这些代谢率上。这些地图可以实现准确的定位 部分性癫痫患者的致痫灶，并可能 允许非侵入性地选择患者进行手术。这又反过来 可能允许具有成本效益的干预措施，并可能增加 手术带来了相应的社会经济收益。

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.