Kuzniecky R, Palmer C, Hugg J, Martin R, Sawrie S, Morawetz R, Faught E, Knowlton R
Department of Neurology, University of Alabama, Birmingham Station, Birmingham, AL 35294, USA.
Arch Neurol. 2001 Dec;58(12):2048-53. doi: 10.1001/archneur.58.12.2048.
Magnetic resonance spectroscopy (MRS) has demonstrated consistent metabolic abnormalities in temporal lobe epilepsy. The reason for decreases in N-acetylated compounds are thought to be related to neuronal hippocampal cell loss as observed in hippocampal sclerosis. However, mounting evidence suggest that the N-acetylated compound decreases may be functional and reversible.
To establish whether the metabolic changes measured by MRS correlate to hippocampal cell loss in temporal lobe epilepsy.
We prospectively performed quantitative hippocampal MR imaging volumetry and MRS imaging in 33 patients with intractable mesial temporal lobe epilepsy who were undergoing surgery. A neuronal-glial ratio of cornu ammonis and fascia dentata was obtained and correlated while validating the pathologic analysis by comparisons with specimens of age-matched autopsy control-case hippocampus (n = 14).
The neuronal-glial ratio of the patient group was statistically significantly lower than in the control group for the cornu ammonis region (P<.001). Correlations of hippocampal volumes with cornu ammonis and neuronal-glial ratios revealed a significant interdependence (P<.01). However, correlations of the resected hippocampal creatine-N-acetylated compound ratio with the cornu ammonis or fascia dentata neuronal-glial ratios showed no significant interdependence (P>.8).
Our findings support the concept that the metabolic dysfunction measured by MRS imaging and the hippocampal volume loss detected by MR imaging volumetry do not have the same neuropathologic basis. These findings suggest that the MRS imaging metabolic measures reflect neuronal and glial dysfunction rather than neuronal cell loss as previously assumed.
磁共振波谱（MRS）已证实在颞叶癫痫中存在一致的代谢异常。N - 乙酰化化合物减少的原因被认为与海马硬化中观察到的海马神经元细胞丢失有关。然而，越来越多的证据表明，N - 乙酰化化合物的减少可能是功能性的且可逆的。
确定MRS测量的代谢变化是否与颞叶癫痫中的海马细胞丢失相关。
我们前瞻性地对33例接受手术的难治性内侧颞叶癫痫患者进行了海马定量磁共振成像容积测量和MRS成像。获得了海马角和齿状回的神经元与神经胶质细胞比例，并进行相关性分析，同时通过与年龄匹配的尸检对照病例海马标本（n = 14）比较来验证病理分析。
患者组海马角区域的神经元与神经胶质细胞比例在统计学上显著低于对照组（P <.001）。海马体积与海马角及神经元与神经胶质细胞比例的相关性显示出显著的相互依赖性（P <.01）。然而，切除的海马肌酸 - N - 乙酰化化合物比例与海马角或齿状回神经元与神经胶质细胞比例的相关性未显示出显著的相互依赖性（P >.8）。
我们的研究结果支持这样的概念，即MRS成像测量的代谢功能障碍和磁共振成像容积测量检测到的海马体积丢失没有相同的神经病理学基础。这些结果表明，MRS成像代谢测量反映的是神经元和神经胶质功能障碍，而不是如先前假设的神经元细胞丢失。
