Savic I, Thomas A M, Ke Y, Curran J, Fried I, Engel J
Dept of Neurology, UCLA, Los Angeles, USA.
Acta Neurol Scand. 2000 Sep;102(3):179-88. doi: 10.1034/j.1600-0404.2000.102003179.x.
To investigate whether cerebral levels of N-acetyl aspartate (NAA), and glutamine + glutamate (Glx), are interictally altered in the epileptogenic regions of patients with partial seizures.
NAA, Glx, creatine (Cr), choline (Cho) and myo-inositol (mI) was measured in 28 patients with partial epilepsy and 10 healthy controls using localized 1H magnetic resonance spectroscopy. According to the multimethodological consensus, the epileptogenic region was mesial temporal in 18 and neocortical in 10 patients.
The Glx/NAA and Glx/Cr ratios in epileptogenic regions were higher, and the NAA/Cr ratios lower than in the homologous regions (P=0.013, P=0.002 and P<0.0001). Applying the 95% confidence interval of controls, 17 of the 20 mesial temporal epileptogenic regions were correctly identified by an increased Glx/NAA and 15 of 20 by a decreased NAA/Cr ratio. Among patients with neocortical epilepsy the Glx/NAA ratio was increased in 8 of the 10 epileptogenic regions, whereas the NAA/Cr ratio was decreased in three.
Both Glx and NAA are useful to identify the epileptogenic zone. The Glx/NAA ratios may be particularly useful to indentify neocortical epileptogenic regions.
研究部分性癫痫患者致痫区域发作间期N-乙酰天门冬氨酸（NAA）及谷氨酰胺+谷氨酸（Glx）水平是否发生改变。
采用局部1H磁共振波谱法对28例部分性癫痫患者及10名健康对照者的NAA、Glx、肌酸（Cr）、胆碱（Cho）和肌醇（mI）进行测量。根据多方法共识，18例患者的致痫区域位于颞叶内侧，10例患者的致痫区域位于新皮质。
致痫区域的Glx/NAA和Glx/Cr比值高于同源区域，而NAA/Cr比值低于同源区域（P=0.013、P=0.002和P<0.0001）。以健康对照者的95%置信区间为标准，20个颞叶内侧致痫区域中有17个通过升高的Glx/NAA正确识别，20个中有15个通过降低的NAA/Cr比值正确识别。在新皮质癫痫患者中，10个致痫区域中有8个Glx/NAA比值升高，而3个区域的NAA/Cr比值降低。
Glx和NAA均有助于识别致痫区。Glx/NAA比值可能对识别新皮质致痫区域特别有用。
