TEMPORAL-LOBE PATHOLOGY IN EPILEPSY - PROTON MAGNETIC-RESONANCE SPECTROSCOPY AND POSITRON EMISSION TOMOGRAPHY STUDY

Hippocampal atrophy characterized by neuronal loss is a common feature in intractable temporal lobe epilepsy in adults, In proton magnetic r esonance spectroscopy, a reduction in N-acetylaspartate or in its rati o to other metabolites is considered a sensitive method for detecting neuronal loss, This noninvasive approach was used to study the tempora l lobes, especially the hippocampal regions of children with partial e pilepsy, In all cases, 2-[F-18]fluoro-2-deoxy-D-glucose scans were stu died to verify the extension of the hypometabolic area, Five children manifested temporal lobe epilepsy; in 2 of them, epilepsy was intracta ble, Both manifested temporal hypometabolism on positron emission tomo graphy, hippocampal atrophy on magnetic resonance imaging, and signifi cant reductions in the metabolite ratios on spectroscopy ipsilateral t o the seizure focus, as verified by EEG, Three children with temporal lobe epilepsy had infrequent seizures, One of them had a reduction in metabolite ratios in the hippocampus and hippocampal atrophy on magnet ic resonance imaging ipsilateral to the seizure focus, The results sho w that the value of proton spectroscopy lies not only in lateralizing hippocampal atrophy but also in detecting bilaterality and the extent of neuronal loss outside hippocampi, This noninvasive preoperative dia gnostic method can be considered an additional technique to be used in conjunction with other imaging techniques for clinical assessment of children with intractable temporal lobe epilepsy. (C) 1997 by Elsevier Science Inc.