Proton spectroscopy in children with epilepsy and febrile convulsions

• Published in: Pediatric neurology Vol. 19; no. 2; pp. 93 - 99
• Main Authors: Holopainen, Irma E, Valtonen, Mauno E, Komu, Markku E, Sonninen, Pirkko H, Manner, Tuula E, Lundbom, Nina M.I, Sillanpää, Matti L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-1998; Elsevier
• Subjects: Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Biological and medical sciences; Child; Child, Preschool; Choline - metabolism; Electroencephalography; Epilepsy - diagnosis; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hippocampus - metabolism; Hippocampus - pathology; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Medical sciences; Nervous system (semeiology, syndromes); Neurology; Phosphocreatine - metabolism; Seizures, Febrile - diagnosis; Temporal Lobe - metabolism; Temporal Lobe - pathology; Human; Temporal lobe; Nervous system diseases; Epilepsy; Exploration; NMR spectrometry; Febrile convulsion; Metabolism; Nuclear magnetic resonance imaging; Cerebral disorder; Central nervous system disease; Medical imagery; Neurological disorder; Localization; Child; Comparative study; Hippocampus
• ISSN: 0887-8994; 1873-5150
• 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.