Doelken M T, Stefan H, Pauli E, Stadlbauer A, Struffert T, Engelhorn T, Richter G, Ganslandt O, Doerfler A, Hammen T
Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
Seizure. 2008 Sep;17(6):490-7. doi: 10.1016/j.seizure.2008.01.008. Epub 2008 Mar 11.
The objective of this study was to quantitate and compare ipsilateral total N-acetyl aspartate (tNAA), creatine (Cr), choline (Cho), myo-inositol (m-Ins) and glutamate plus glutamine (Glx) levels in the hippocampi of patients with temporal lobe epilepsy (TLE) with and without magnetic resonance imaging (MRI) evidence for mesial temporal sclerosis (MRI positive/negative).
Twenty-three age matched healthy controls and 26 consecutive patients with unilateral TLE, based on intensive 24h video-EEG, were investigated with proton magnetic resonance spectroscopy ((1)H-MRS) (17 with unilateral hippocampal sclerosis (HS) in MRI-MRI positive; 9 MRI negative). For statistical analysis one-way analysis of variance (ANOVA) with post hoc multiple comparisons and Bonferroni correction was applied. The significance level was based on p<0.05.
The mean tNAA level ipsilateral to the seizure focus was significantly decreased in MRI negative, respectively MRI positive patients in comparison to healthy controls (p<0.001). The lowest tNAA level was noticed in the MRI positive group (p<0.001). Statistical analysis highlighted a clear "tNAA cut-off" (95% confidence interval) between MRI positive- and MRI negative patients and healthy controls. Mean level of Glx and m-Ins was not significantly elevated or reduced. However, in individual cases a significant elevation was noticed for Glx in MRI negative patients, respectively for m-Ins in MRI positive patients.
MRI negative TLE patients have a different MRS profile than MRI positive patients (HS) with marginal but significant decrease of tNAA. Our results reveal a clear "tNAA cut-off" between the groups. The value of m-Ins and Glx in focus detection in TLE patients remains controversy.
本研究的目的是对有或无内侧颞叶硬化磁共振成像（MRI）证据（MRI阳性/阴性）的颞叶癫痫（TLE）患者海马中同侧总N-乙酰天门冬氨酸（tNAA）、肌酸（Cr）、胆碱（Cho）、肌醇（m-Ins）以及谷氨酸加谷氨酰胺（Glx）水平进行定量并比较。
基于24小时强化视频脑电图，对23名年龄匹配的健康对照者和26例连续的单侧TLE患者进行了质子磁共振波谱（（1）H-MRS）检查（17例MRI显示单侧海马硬化（HS）——MRI阳性；9例MRI阴性）。采用单因素方差分析（ANOVA）及事后多重比较和Bonferroni校正进行统计分析。显著性水平设定为p<0.05。
与健康对照者相比，MRI阴性和MRI阳性患者癫痫灶同侧的平均tNAA水平均显著降低（p<0.001）。MRI阳性组的tNAA水平最低（p<0.001）。统计分析突出显示了MRI阳性和MRI阴性患者与健康对照者之间存在明显的“tNAA临界值”（95%置信区间）。Glx和m-Ins的平均水平未显著升高或降低。然而，个别病例中，MRI阴性患者的Glx水平显著升高，MRI阳性患者的m-Ins水平显著升高。
MRI阴性的TLE患者与MRI阳性（HS）患者具有不同的MRS特征，tNAA有轻微但显著的降低。我们的结果揭示了不同组之间存在明显的“tNAA临界值”。m-Ins和Glx在TLE患者病灶检测中的价值仍存在争议。
