A Study Of H-magnetic Resonance Spectroscopy On Bilateral Thalamus Of Patients With Single Partial And Secondarily Generalized Seizures

Aim:Quantitative analysis of the metabolite ratio in the thalamus bilaterally in patients with simple partial seizure and simple partial seizure with generalization to form tonicclonic seizure through magnetic resonance spectrum. Also, to observe whether simple partial seizure and secondary generalized seizure affect the metabolism of the thalamus as well as to explore the role of the thalamus in the pathogenesis of partial seizure.Methods:According to the 2007 Chinese Medical Association edition of "Clinical Practice Guidelines, epilepsy manual” of diagnostic criteria and the 1981 International League Against Epilepsy(ILAE) publication about the international classification standards, patients admitted to the First Affiliated Hospital of Dalian medical university were screened for simple partial seizures(SPS) and simple partial seizure with generalization to form tonic-clonic seizure. The clinical trial included a total of 24 patients aged from 18-50 years old, among whom 13 patients had SPS and 11 patients were diagnosed with SGS. In line with this, a healthy control group of 18 patients was also included. All the subjects revealed no abnormalities on 1.5T MRI head scan performed in the above mentioned hospital. Through proton magnetic resonance spectroscopy, both thalami were screened for their N- acetyl aspartate(NAA), choline(Cho), creatine and phosphocreatine(Cr-PCr) and other metabolites level. Control group, SPS group and SGS Group NAA/Cr-PCr, NAA/(Cr-PCr+Cho), Cho/Cr-PCr ratio were compared among each other and also, seizure frequency, duration and factors influencing the thalamic metabolism were noted. The collected data were compared through the use of SPSS 19.0 and presence of statistical significance was considered if P<0.05.Result:The left and right thalamus metabolism were analyzed through sample t-test. No relative difference in the metabolite ratio values of the right and left thalamus were found when control group, SPS and SGS group were compared. Furthermore, age and gender do not affect the metabolite ratio. Normal control group left thalamus NAA /(Cr-PCr + Cho), NAA / Cr-PCr, Cho / Cr-PCr mean ratio values were 0.90 ± 0.03,1.82 ±0.05,1.23 ± 0.04 respectively; Right thalamus NAA /(Cr-PCr + Cho), NAA / Cr-PCr,Cho / Cr-PCr mean ratio values were 0.87 ± 0.03,1.72 ± 0.06,1.14 ± 0.04 respectively.SPS group left thalamus NAA /(Cr-PCr + Cho), NAA / Cr-PCr, Cho / Cr-PCr mean ratio values were 0.82 ± 0.04, 1.81 ± 0.06,1.36 ± 0.07 respectively; Right thalamus NAA /(Cr-PCr + Cho), NAA / Cr-PCr, Cho / Cr-PCr mean ratio values were 0.82 ±0.03,1.75 ± 0.06,1.24 ± 0.05 respectively. SGS group left thalamus NAA /(Cr-PCr +Cho), NAA / Cr-PCr, Cho / Cr-PCr mean ratio values were: 0.79 ± 0.04,1.58 ± 0.07,1.29± 0.07; Rght thalamus NAA /(Cr-PCr + Cho), NAA / Cr-PCr, Cho / Cr-PCr mean ratio values were: 0.72 ± 0.02,1.51 ± 0.05,1.20 ± 0.04. Comparison of the thalamus metabolite ratio values of SPS group and normal control group showed no significant difference. Statistical significance was noted when comparing the thalami NAA /Cr-PCr, NAA /(Cr-PCr+Cho) metabolite ratio, especially the SGS group, whose values were lower than the control group(Left thalamus P = 0.031, 0.022, while right thalamus P = 0.018, 0.012; but Cho / Cr-PCr of both groups were not different). When SPS and SGS groups are compared, statistical significance was noted only concerning the NAA/Cr-PCr level, however the bilateral NAA /(Cr-PCr+Cho) shows no significant difference, while the other ratios showed no statistical difference. Seizure frequency and disease duration in the SPS and SGS groups were not found to influence the metabolite ratios of the thalamus.Conclusion:1. Magnetic resonance spectrum technology can be found that the MRI negative part of the cerebral metabolic abnormalities in patients with simple partial epilepsy.2. Comparison of the thalamus metabolite ratio values of SPS group and normal control group showed no significant difference, prompt no bilateral thalamus neurons metabolic abnormalities3. When SGS group compared with normal control group bilateral thalamus NAA/Cr-PCr, NAA/Cr- PCr + Cho) ratio decreased, compared with the SPS group NAA/Cr- PCr ratio decreased, prompt patients with SGS have bilateral thalamus metabolite abnormalities.