Study On The Relationship Between The Changes Of Metabolites Detected By ~1H-MRS In The Diagnosis Of Temporal Lobe Epilepsy And The Evaluation Of Drug Therapy

Objective:To explore the clinical value of 1H Magnetic Resonance S pectrosecpy,1H MRS in lateralization and evaluation of epileptic foci in t emporal lobe epilepsy(Temporal lobe epilepsy,TLE).Methods:According to the criteria for judging the curative effect of level 4 formulated by the first National Epilepsy academic Conference of the Chinese Medical Ass ociation,85 patients with temporal lobe epilepsy were treated effectively.Ba sed on the reexamination of interictal epileptiform discharge(Interictal epile ptiform discharges IEDs).85 patients with temporal lobe epilepsy were divi ded into non-interictal epileptic discharge group(non-Interictal epileptiform discharges NIEDs)and interictal epileptic discharge group(Interictal epilepti formdischarges IEDs).30 healthy volunteers were recruited as the control gr oup.All subjects were examined by 24-hour ambulatory electroencephalogra m(Active Electroencephalography,AEEG),skull MRI and brain ~1H MRS.T he contents of N-acetylaspartate(NAA),creatine(Cr)and choline(Cho)i n bilateral hippocampus of the three groups were measured.The changes o f the ratio of NAA/(Cr+Cho),NAA/Cr and NAA/Cho were statistically a nalyzed and compared with the results of AEEG and head MRI.Results:(1)In the epilepsy group,64 cases had abnormal AEEG(75.3%),42 cases could be located laterally(42.2%),24 cases could be located on the left side(24.2%),18 cases were located on the right side(21.2%),and 22 c ases could not be localized laterally(25.8%),Routine MRI scan showed h ippocampal atrophy in 3 cases(3.5%,including 2 on the left and 1 on th e right).81 cases of abnormalities were recorded by ~1H MRS(95.3%),58cases with bilateral abnormalities(58%),and 23 cases with unilateral abn ormalities(23%).The coincidence rate of ~1H MRS and AEEG in the loca lization of epileptogenic foci was 51.8%.(2)Compared with the control gro up,NAA/(Cr+Cho),NAA/Cr and NAA/Cho in the EP disease side group were significantly lower than those in the control group(P<0.01).NAA/(Cr+Cho)and NAA/Cho in the EP contralateral side group were signific antly lower than those in the control group(P<0.05).The ratio of NAA/Cr was lower than that in the control group,but the decrease was not sta tistically significant(P>0.05).(3)The indicators of in IEDs group and NIE Ds group were lower than those in control group(P<0 01),IEDs group was lower than that in NIEDs group(P<0 05).(4)The values of the abov e three indexes in atrophic HS group and non-atrophic HS group were si gnificantly lower than those in control group(P<0.01 or P<0.05).(5)In the ipsilateral and contralateral side groups of EP,the ratio of NAA/(Cr+Cho)was negatively correlated with the frequency of seizures,while the r atio of NAA/(Cr+Cho)had no significant correlation with the age and c ourse of onset.There was no significant correlation between the ratio of NAA/Cr and NAA/Cho and the age,course and frequency of onset.Conc lusions:(1)~1H-MRS is a non-invasive neuroimaging technique,which is mo re sensitive to the detection of metabolic changes in patients with epileps y than conventional brain MR imaging.~1H-MRS can be used as an import ant method for lateralization of epileptogenic foci in temporal lobe epileps y with negative MRI.(2)The content and ratio of epilepsy-related metabolit es in IEDs group were lower than those in NIEDs group,reflecting the s everity of neuronal injury and dysfunction.These findings can be used as an auxiliary index to predict the prognosis of which patients with TLE.