Abstract
This chapter discusses the potential clinical application of proton magnetic resonance spectroscopy (MRS) in localizing the epileptogenic focus in temporal lobe epilepsies (TLE). A large number of proton-containing metabolites can be detected simultaneously by in situ proton MRS that includes N-acetylaspartate (NAA), choline (Cho), creatine (Cr), lactate, gamma-aminobutyric acid (GABA), glutamine, glutamate, alanine, lipids, and other neurochemical molecules. The number of neurochemicals detected by MRS highly depends on the acquisition parameters employed, such as echo time and repetition rate of pulse sequences. The single-voxel approach greatly reduces the sensitivity and versatility of MRS in determining the disease focus. Both in situ proton and phosphorous MRS have shown changes in metabolite profiles of the normal brain during development. It is found that in proton MRS studies of normal infants, decreased Cho/Cr, and increased NAA/Cho and NAA/Cr ratios with increasing age are observed. It is suggested that the noninvasive proton MRS appears to be potentially useful in localizing pediatric temporal epileptic foci as well, despite the age-dependent variation in MRS metabolites in the developing brain.
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