PROTON MAGNETIC-RESONANCE SPECTROSCOPY IN CHILDREN WITH TEMPORAL-LOBEEPILEPSY

We performed proton magnetic resonance spectroscopy of the mesial temp oral regions in 20 children with intractable temporal lobe epilepsy an d compared results with those from 13 normal subjects. Abnormalities o f the ratio of N-acetylaspartate to choline plus creatine (NAA/[Cho+Cr ]) were seen in 15 patients (75%). The ratio NAA/(Cho+Cr) was correctl y lateralizing in 55% and incorrectly lateralizing in none. Bilateral abnormalities were seen in 45%. Overall there was a unilateral decreas e in N-acetylaspartate on the side ipsilateral to the seizure focus (m ean 19% decrease vs normals, with 5% decrease on the contralateral sid e), suggesting neuronal loss or dysfunction. There was also a bilatera l increase in creatine and choline (mean 18%), consistent with reactiv e astrocytosis. We conclude that proton magnetic resonance spectroscop y can contribute to lateralization of the seizure focus, and by detect ion of bilateral abnormalities, can contribute to the understanding of the underlying pathophysiology in temporal lobe epilepsy.