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Magnetic resonance spectroscopy in temporal lobe epilepsy

Radiology and Physics Unit (Drs. Connelly, King, and Gadian) and the Neurosciences Unit (Dr. Jackson), Institute of Child Health, and the Epilepsy Research Group (Dr. Duncan), Institute of Neurology, Queen Square, London, UK.

We used proton magnetic resonance spectroscopy (¹H MRS) to investigate the temporal lobes of 25 patients with temporal lobe epilepsy. Spectra were obtained from 2 x 2 x 2 cm cubes in the medial region of the temporal lobe, and were analyzed on the basis of signals from N-acetylaspartate (NAA), creatine + phosphocreatine (Cr), and choline-containing compounds (Cho). In comparison with control subjects, the temporal lobes ipsilateral to the seizure focus showed a mean reduction of 22% in the NAA signal, with a 15% increase in the Cr signal and a 25% increase in the Cho signal. There were smaller effects in the contralateral temporal lobes. These spectral abnormalities may reflect neuronal loss or damage, together with reactive astrocytosis. The NAA/Cho+Cr ratio was abnormally low in 88% of the patients, 40% showing bilateral effects. On the basis of the NAA/Cho+Cr ratio, we correctly achieved lateralization in 15 cases, with three incorrect. Two of the incorrect lateralizations also had imaging abnormalities on the contralateral side, and the other had severe bilateral abnormalities on MRS. We conclude that 1H MRS provides useful information in the preoperative investigation of patients with temporal lobe epilepsy, contributing to lateralization and detecting bilateral abnormalities.

Address correspondence and reprint requests to Prof. David G. Gadian, Radiology and Physics Unit, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.

Supported by Action Research and the Wellcome Trust.

Received September 22, 1993. Accepted in final form January 28, 1994.

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