Holopainen I E, Valtonen M E, Komu M E, Sonninen P H, Manner T E, Lundbom N M, Sillanpää M L
Department of Pediatric Neurology, University Hospital of Turku, Finland.
Pediatr Neurol. 1998 Aug;19(2):93-9. doi: 10.1016/s0887-8994(98)00028-9.
An association between complex febrile convulsions and the development of hippocampal atrophy, which is characterized by neuron loss and gliosis, has been suggested but is still controversial. In proton magnetic resonance spectroscopy (1H-MRS) a reduction in N-acetylaspartate (NAA), a neuron marker, or in its ratio to other metabolites, that is, creatine and phospocreatine (Cr) and choline-containing compounds (Cho), is considered a sensitive method for detecting neuron loss. We performed 1H-MRS of mesial temporal regions, including hippocampi, in two different groups of children with epilepsy: in children with a history of complex febrile convulsions (CFCs) (n = 7; mean age 7.1 years) and in children without any history of CFCs, referred to herein as the non-CFC group (n = 6; mean age 7.6 years). Changes in the metabolite ratios were detected in 57% of children in the CFC group and in 67% of children in the non-CFC group. In both groups, NAA/(Cho + Cr), NAA/Cho, and NAA/Cr were significantly decreased ipsilaterally to the seizure focus when compared with the control group, but no significant differences were detected between the CFC and non-CFC groups. Also on the contralateral side, NAA/(Cho + Cr) and NAA/Cr were significantly decreased in both patient groups, but the differences were not significant between the CFC and non-CFC groups. Metabolite abnormalities in the mesial temporal region were detected in children with intractable epilepsy and in children whose epilepsy is well controlled by antiepileptic medication. The noninvasive 1H-MRS can be considered an additional diagnostic method to promote early detection of mesial temporal abnormalities that, in the light of this study, seem to be underdiagnosed in children with either temporal lobe epilepsy or other seizure types.
复杂热性惊厥与海马萎缩的发展之间存在关联，海马萎缩的特征是神经元丢失和胶质增生，这一关联已被提出，但仍存在争议。在质子磁共振波谱（1H-MRS）中，神经元标志物N-乙酰天门冬氨酸（NAA）或其与其他代谢物（即肌酸和磷酸肌酸（Cr）以及含胆碱化合物（Cho））的比率降低，被认为是检测神经元丢失的敏感方法。我们对两组不同的癫痫儿童进行了包括海马在内的内侧颞叶区域的1H-MRS检查：有复杂热性惊厥病史（CFCs）的儿童（n = 7；平均年龄7.1岁）和无CFCs病史的儿童，本文中称为非CFC组（n = 6；平均年龄7.6岁）。CFC组57%的儿童和非CFC组67%的儿童检测到代谢物比率变化。与对照组相比，两组中，癫痫灶同侧的NAA/（Cho + Cr）、NAA/Cho和NAA/Cr均显著降低，但CFC组和非CFC组之间未检测到显著差异。在对侧，两组患者的NAA/（Cho + Cr）和NAA/Cr也显著降低，但CFC组和非CFC组之间的差异不显著。在难治性癫痫儿童和癫痫通过抗癫痫药物得到良好控制的儿童中均检测到内侧颞叶区域的代谢物异常。鉴于本研究，无创性1H-MRS可被视为一种辅助诊断方法，以促进内侧颞叶异常的早期检测，内侧颞叶异常在颞叶癫痫或其他发作类型的儿童中似乎未得到充分诊断。
