Application Of~1Hydrogen Proton Magnetic Resonance Spectroscopy In Patients With Temporal Lobe Epilepsy

Objective To study the application value of3.0Tesla MR multi-volex1H-MRS inthe lateralization and location diagnosis of temporal lobe epilepsy and in the earlydiagnosis of hippocampal sclerosis. Further understanding the correlation betweenseizure and metabolic dysfunction of neuron and glial cells in the hippocampus byMRS in patients with temporal lobe epilepsy (TLE). And preliminary study whetherdouble side frontal lobe exist metabolic dysfunction or loss of neuron in the patientswith temporal lobe epilepsy. Preliminary understanding the phenomenon of mirrorfocus and the general law of metabolic concentration in different hippocampalformation.Methods and Materials58patients, who have been diagnosed as TLE bycomprehensive use of clinical history and neurological examination, scalp EEG withsphenoidal electrodes, conventional magnetic resonance imaging (cMRI), and thenmulti-volex proton MR chemical shift imaging was performed. There were36menand32women with the age of4to80years （mean age,26.4years）.40healthyvolunteers with known history of no neurological disease were recruited as controlgroup.1. Statistical results show that in the temporal lobe epilepsy patients the ratio of NAA/(Cr+Cho) was significantly decreased in the head, body and tail of the hippocampusin the TLE compared to the control group. Choose independent sample t-test method,we think P＜0.05, the difference was statistically significant.2. An analysis was performed in the correlation between the ration of NAA/(Cr+Cho)and duration of epilepsy, which found there was no correlation between them.3.To explore whether the ratio of NAA/Cr and NAA/(Cr+Cho) between in frontallobe ipsilateral to epileptogenic foci and healthy volunteers was different, Chooseindependent sample t-test method, we think P＜0.05，the difference was statisticallysignificant. 4.To analyzing and arranging the results of those patients who could notlocalization.5. To analysis the ratio of NAA/(Cr+Cho) in head, body and tail of the hippocampusin the TLE patients and healthy volunteers, Choose variance analysis test, we thinkwhen P＜0.05,the difference was statistically significant.Results1.The ratio of NAA/(Cr+Cho) was significantly decreased in the head, body and tailof the hippocampus in the TLE compared to the control group. Especially for thehippocampus ipsilateral to epileptogensis foci.2. In the TLE patients, no significant correlation was found in the duration of epilepsyhistory with the ratio of NAA/(Cr+Cho) in the hippocampus ipsilateral toepileptogenic foci, and neither was in the hippocampus contralateral to epileptogensisfoci.3. In the TLE patients，the ratio of NAA/Cr and NAA/(Cr+Cho) in the frontal lobeipsilateral to epileptogenic foci was significantly decreased compared to the controlgroup.4. According to clinical history and neurological examination, scalp EEG withsphenoidal electrodes, conventional magnetic resonance imaging (cMRI), andmulti-voxel MR chemical shift imaging,39patients can lateralization. But there arealso19patients can not lateralization, which account for32.8%.5. The ratio of NAA/(Cr+Cho) tend to increase gradually both hippocampi from thehead to tail in patients with TLE and in the control.Conclusions1. Our findings suggested that neuronal cell loss or dysfunction may occur in thehippocampus ipsilateral to the epileptogensis foci with temporal lobe epilepsy.Especially in the head and body of the hippocampus ipsilateral to the epileptogensisfoci.2. The worsening of epilepsy disease was not connect with the duration of epilepsyhistory, tips for epilepsy may be an early form of fixed lesions, rather than aprogressive disease.3. Patients with temporal lobe epilepsy, whose frontal lobe also exist neuronal cell loss or dysfunction, so temporal lobe epilepsy maybe was a diffuse disease in thebrain.4. The mirror focus phenomenon exists, but not all of the TLE patients will appear intheir disease career.5. It is a general law that the ratio of NAA/(Cr+Cho) tended to increase graduallyalong with hippocampi from head to tail.