Li L M, Dubeau F, Andermann F, Arnold D L
Department of Neurology and Neurosurgery and the Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
Epilepsia. 2000 Jul;41(7):825-31. doi: 10.1111/j.1528-1157.2000.tb00249.x.
To assess whether the N-acetyl aspartate (NAA) to creatine ratio (NAA/Cr) is abnormally low at the onset of epilepsy and whether successful treatment of seizures with antiepileptic drugs is sufficient for normalization of NAA/Cr.
Proton magnetic resonance spectroscopic imaging (1H-MRSI) was used to measure NAA/Cr in temporal lobes of eight patients with newly diagnosed epilepsy before or soon after starting medication. Six patients had follow-up 1H-MRSI examinations 7 months later. Clinical pattern of the seizures and the EEG findings suggested partial seizures in all and TLE in five patients. None of the patients had lesional epilepsy according to magnetic resonance imaging.
Initial 1H-MRSI of the temporal lobes showed significantly low NAA/Cr values in five of eight patients. Five of six patients who had follow-up 1H-MRSI were seizure-free after using medication; the remaining patient did not take medication and continued to experience occasional auras. Wilcoxon rank sign comparison of NAA/Cr on initial 1H-MRSI examination and follow-up 1H-MRSIs showed no significant difference (Z = 135, p = 0.893, 2-tailed) for five seizure-free patients.
Neuronal dysfunction is present at an early stage of the epileptic process. NAA/Cr recovery in seizure-free patients controlled with antiepileptic drugs is less evident, compared with successful surgical treatment. Thus, absence of seizures is not necessarily coupled with NAA/Cr improvement and observed variable response warrants further investigation.
评估癫痫发作开始时N-乙酰天门冬氨酸（NAA）与肌酸的比值（NAA/Cr）是否异常降低，以及抗癫痫药物成功控制癫痫发作是否足以使NAA/Cr恢复正常。
使用质子磁共振波谱成像（1H-MRSI）测量8例新诊断癫痫患者在开始用药前或用药后不久颞叶的NAA/Cr。6例患者在7个月后进行了1H-MRSI随访检查。癫痫发作的临床模式和脑电图结果提示所有患者均为部分性发作，5例为颞叶癫痫。根据磁共振成像，所有患者均无病灶性癫痫。
8例患者中5例颞叶的初始1H-MRSI显示NAA/Cr值显著降低。6例进行随访1H-MRSI的患者中，5例用药后无癫痫发作；其余1例未用药，仍偶尔出现先兆症状。对癫痫发作未再出现的5例患者的初始1H-MRSI检查和随访1H-MRSI的NAA/Cr进行Wilcoxon秩和检验，差异无统计学意义（Z = 135，p = 0.893，双侧）。
癫痫过程早期存在神经元功能障碍。与成功的手术治疗相比，抗癫痫药物控制发作患者的NAA/Cr恢复不太明显。因此，癫痫发作消失不一定伴随着NAA/Cr改善，观察到的可变反应值得进一步研究。
