Clinical Research Of "Cocktail" Therapy Repair The Epilepsy Patients' Hippocampal Sclerosis

Objective:Hippocampal sclerosis is also known as mesial temporal sclerosis,the main pathological features is the loss of neurons and glial cell proliferation.Conventional MRI has good soft tissue resolution,could found hippocampal sclerosis and signal changes in medial temporal lobe hippocampal sclerosis,therefore,it is safe and specific method.However,only hippocampal sclerosis reach to some extent or hippocampal atrophy that conventional MRI can showed abnormalities.The early hippocampal sclerosis is mainly manifested as conventional MRI negative,however,the ratio of NAA/Cho + Cr in proton nuclear magnetic resonance spectroscopy is lower than normal.The 'Hydrogenproton magnetic resonance spectroscopy(1Hydrogenproton magnetic resonance spectroscopy 1H-MRS)as a noninvasive method,Which make a further study of hippocampal function changes from neural biochemical metabolism.The metabolite spectrum changes are earlier than MRI morphological changes.1Hydrogenproton magnetic resonance spectroscopy can make a diagnosis of early mild hippocampal sclerosis,therefore,it is more sensitive than conventional MRI.Conventional MRI and 1Hydrogenproton magnetic resonance spectroscopy check again for patients with hippocampal sclerosis after a period of antiepileptic drug and "cocktail" therapy,who diagnosed by conventional MRI and 'Hydrogenproton magnetic resonance spectroscopy clearly.The purpose of this study is to understand the situation of hippocampal sclerosis after treatment and to explore the mechanism causing the change.Methods:The present study was performed in 30 epilepsy patients with hippocampal sclerosis,who were diagnosed at the Second Hospital of Lanzhou University,Epilepsy Center,from February 2012 to February 2013.18 males and 12 females,aged 5 to 34 years old,with an average age of 18 years old.Duration of the disease form 1 to 25 years,with an average of 6.7 years.Clear cause in 14 cases(46.7%),single etiology in 8 cases,6 cases with multiple etiologies,Seizure types for temporal lobe epilepsy in 10 cases,2 cases of aura continua,Secondarily generalized tonic-clonic seizures in 11 cases,simple partial seizure in 1 case,partial seizures with secondarily generalized tonic-clonic seizure 6 cases.These patients underwent conventional MRI and 1Hydrogenproton magnetic resonance spectroscopy before and after treatment.SPECT and V-EEG were also given to observe whether there are changes in conventional MRI and 1Hydrogenproton magnetic resonance spectroscopy after treatment.The main observation items of conventional MRI about hippocampal sclerosis were hippocampal volume,internal morphological structure of the hippocampus,signal intensity of the hippocampus,temporal horn size,temporal lobe size and the collateral white matter.1Hydrogen proton magnetic resonance spectroscopy mainly observed the peaks features of NAA?Cr?Cho,at the same time,NAA/(Cr + Cho)values was calculated and analyzed.Results:Among 30 epileptic patients,conventional MRI(+)in 12(40%)patients before treatment.The main performance of hippocampal sclerosis were hippocampal atrophy,high signal intensity of the hippocampus and enlargement of the temporal horn.Among the 12 patients,lcases had hippocampal atrophy,4 cases had high signal intensity of the hippocampus,3 cases had hippocampal atrophy and enlargement of the temporal horn,4 cases had hippocampal atrophy and high signal intensity of the hippocampus.The rest 18(60%)patients with conventional MRI(-),proton nuclear magnetic resonance spectroscopy NAA/(Cr + Cho)reduced,suggesting that early hippocampal sclerosis.Distribution site,the left hippocampal sclerosis in 16 cases(53.3%),the right hippocampus sclerosis in 3 case(10%),bilateral hippocampal sclerosis in 11 cases(36.7%).Conventional MRI and 1H-MRS were checked again after antiepileptic drugs and fluid therapy.The results showed that among 18 cases of patients who only had 1H-MRS abnormalities,16 cases(88.9%)showed normal conventional MRI examination and the ratio of NAA/(Cr + Cho)returned to normal,2cases(11.1%)showed hippocampal atrophy,high signal intensity of the hippocampus and the enlargement of temporal horn,meanwhile,the ratio of NAA/(Cr + Cho)reduced further Among the remaining 12 patients who were received the conventional MRI and 'H-MRS again after antiepileptic drugs and fluid therapy,8 cases(66.7%)almost unchanged,2cases who had high signal intensity of the hippocampus showed high signal intensity of the hippocampus and hippocampal atrophy,2cases who had hippocampal atrophy showed hippocampal atrophy and significant expansion of the temporal horn.Overall,there were 16 cases whose hippocampal sclerosis diagnosed by conventional MRI and 1H-MRS has returned to normal after antiepileptic drugs and fluid therapy,increase by 53.3%,had statistically significant difference(?2=21.8.18 P<0.05).Conclusion:(1)Hippocampal sclerosis may show hippocampal atrophy,high signal intensity of the hippocampus,enlargement of the temporal horn and ratio decrease of NAA/(Cr + Cho)in conventional cranial MRI and 1H-MRS;(2)1 H-MRS can detect early mild hippocampal sclerosis,and has a higher sensitivity in the diagnosis of hippocampal sclerosis;(3)Early mild hippocampal sclerosis can be manifested in the ratio decrease of NAA/(Cr + Cho)and can be restored to normal after treatment,which suggests that early and aggressive treatment can improve the hippocampus local metabolic and early mild hippocampal sclerosis might be reversed.Therefore,when cranial MRI negative and analysis of 1H-MRS performs NAA/(Cr +Cho)value decrease,active treatment should be given to prevent and slow the progression of the disease."Cocktail" therapy combined with anti-epileptic drugs can repair early hippocampal sclerosis in patients with epilepsy.