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Lateralization of human focal epilepsy by ³¹P magnetic resonance spectroscopic imaging

MR Unit (Drs. Hugg, Matson, Maudsley, Husted, and Weiner), Department of Veterans Affairs Medical Center, San Francisco, CA; and the Departments of Radiology (Drs. Hugg, Maudsley, Husted, and Weiner), Neurology (Dr. Laxer), Pharmaceutical Chemistry (Dr. Matson), and Medicine (Dr. Weiner), University of California, San Francisco, CA.

We attempted to lateralize the epileptogenic focus (seven temporal lobe hippocampal foci, one frontal lobe focus) in medically refractory unilateral complex partial seizures, using noninvasive ³¹P magnetic resonance spectroscopic imaging (MRSI) blindly and interictally to compare hippocampal or frontal regions. The seizure foci were more alkaline (intracellular pH = 7.17 ± 0.03) compared with the contralateral region (7.06 ± 0.02, p < 0.01) in all eight cases; the inorganic phosphate was relatively increased (240 ± 50% of contralateral, seven of eight cases, p < 0.01); and phosphomonoesters were relatively reduced (68 ± 9% of contralateral, seven of eight cases, p < 0.01). Other phosphorus metabolites were symmetric (± 10%). ³¹P MRSI correctly lateralized the seizure focus in all eight cases. By comparison, imaging correctly lateralized four cases and SPECT, two cases. In conclusion, ³¹P MRSI is a useful tool for the noninvasive clinical assessment of focal epilepsy and can accurately lateralize the epileptogenic focus.

Address correspondence and reprint requests to Dr. James W. Hugg, Department of Neurology/Research, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202–2689.

This work was supported by NIH grants HL07192 (J.W.H. through the UCSF Cardiovascular Research Institute), R01-DK33293 (M.W.W.), and R01-CA48815 (A.A.M.), Philips Medical Systems, and the Department of Veterans Affairs Medical Research Service (M.W.W.).

Received November 26, 1991. Accepted for publication in final form March 25, 1992.

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