Gabis Lidia, Belman Anita, Huang Wei, Milazzo Maria, Nachman Sharon
Child Development Center, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel 52621.
J Child Neurol. 2006 Jun;21(6):486-90.
In the initial assessment of children with new-onset seizures, the suggestion that electroencephalography (EEG) should be standard and that magnetic resonance imaging (MRI) should be optional has been questioned. The purposes of this children (four boys) with vertically transmitted stable HIV infection had a neurologic examination, neuropsychologic testing, and a neuroimaging study. The structural magnetic resonance imaging (MRI) and metabolic changes (magnetic resonance spectroscopy) were compared with the cognitive, clinical, and laboratory results. Our results for the eight children who completed the magnetic resonance spectroscopic study showed that a high N-acetylaspartate (NAA) to choline ratio correlated significantly with IQ subtests of arithmetic (r = .74; P < .034) and comprehension (r = .77; P = .025). Our results suggest that lower NAA and higher choline values represent neuronal dysfunction and inflammation that can be recognized before anatomic changes appear on MRI. In addition, a low NAA to Cho ratio correlated with poor performance. These data suggest that magnetic resonance spectroscopy can be used as a follow-up tool in addition to the structural MRI. Moreover, a change in a child's performance with a concomitant change in NAA and choline, as measured with magnetic resonance spectroscopy, could indicate the need for more aggressive intervention.
在对新发癫痫患儿的初步评估中，关于脑电图（EEG）应作为标准检查且磁共振成像（MRI）应为可选检查的建议受到了质疑。对4名患有垂直传播稳定HIV感染的儿童（4名男孩）进行了神经系统检查、神经心理学测试和神经影像学研究。将结构磁共振成像（MRI）和代谢变化（磁共振波谱）与认知、临床和实验室结果进行了比较。我们对完成磁共振波谱研究的8名儿童的结果显示，高N-乙酰天门冬氨酸（NAA）与胆碱比值与算术IQ子测试（r = 0.74；P < 0.034）和理解IQ子测试（r = 0.77；P = 0.025）显著相关。我们的结果表明，较低的NAA和较高的胆碱值代表神经元功能障碍和炎症，这在MRI上出现解剖学变化之前就能被识别。此外，低NAA与胆碱比值与较差的表现相关。这些数据表明，除了结构MRI外，磁共振波谱还可作为一种随访工具。此外，通过磁共振波谱测量，儿童表现的变化与NAA和胆碱的伴随变化可能表明需要更积极的干预。
