N-acetylaspartate To Creatine Ratio Research Articles

MRI graph parameters are longitudinal markers of neuronal integrity in multiple sclerosis

PurposeWe sought to determine if structural network parameters add to traditional markers of MS treatment response following immunoablation and autologous haemopoietic stem cell transplantation (IAHSCT). The post-IAHSCT paradigm afforded us the opportunity to study MS patients after relapsing biology had been effectively suppressed, enabling us to study the cortical substrate of progressive MS in a less confounded manner. MethodsIn this analysis of data from a phase 2 prospective study, associations between magnetic resonance graph parameters, N-acetylaspartate to creatine ratio (NAA/Cr), and serum neurofilament light chain (sNfL), amongst other markers, were assessed at 3 months pre-and 12 months post-IAHSCT. Correlations between graph parameter score changes and markers of brain health were calculated. Predictive factors of NAA/Cr or sNfL levels were calculated, adjusting for reference models. Model improvements were evaluated using the G2 likelihood-ratio test. Results24 patients (aged 18–38) were evaluated. Post-IAHSCT, high NAA/Cr and low sNfL (both measures of neuronal injury) were respectively associated with more favourable degree, density, clustering and path lengths, and degree, γ, and path length. Post-IAHSCT, absolute change in degree, path length and γ were associated with NAA/Cr and sNfL. Multivariate analysis demonstrated that the relative change in network parameters after IAHSCT accounted for 14% and 35% more variance in NAA/Cr and sNfL levels respectively than the reference model alone. ConclusionsCross-sectionally and longitudinally, network parameters demonstrate added utility as markers of disease severity in MS. These measures have the potential to capture cortical changes relevant to progressive non-relapsing biology in MS.

P.171 Primary motor cortex metabolite levels correlate with dexterity following spinal surgery for degenerative cervical myelopathy

Background: Spinal cord compression from degenerative cervical myelopathy is characterized by progressive loss of hand dexterity, alongside changes in the metabolite profiles in the brain and spinal cord. Correlating the changing metabolite profile with measures of dexterity following decompression surgery may assist in identifying which patients may benefit most from surgery. Methods: Thirty operative myelopathy patients consented to receive spectroscopy and GRASSP-M dexterity assessments both preoperatively and 6-weeks postoperatively. Magnetic resonance spectroscopy (TE=135) was performed in the motor cortex using a 3 Tesla Siemens MRI scanner at Robarts Research Institute. Spearman correlations were used to evaluate associations between metabolite levels and dexterity (p<0.05 was considered significant). Paired two-tailed Student t-tests were used to assess for postoperative changes in metabolite levels. Results: Postoperatively, we observed a statistically significant (p<0.05) negative correlation (r=-0.44) between the N-acetylaspartate-to-creatine ratio (NAA/Cr) and GRASSP-M dexterity scores. There was no significant difference in NAA, Cr, or NAA/Cr postoperatively. Conclusions: These findings demonstrate that patients with lower postoperative NAA/Cr usually have better recovery of dexterity. This link between the myelopathic metabolite profile and clinically meaningful dexterity values requires further investigation to understand the role of both NAA and Cr in mechanisms of postoperative recovery from myelopathy.

Effect of modified electroconvulsive therapy on neuro metabolites and magnetic resonance spectroscopy imaging signals in patients with refractory obsessive-compulsive disorder

ObjectiveThis study was aimed to investigate the effect of modified electroconvulsive therapy (MECT) on neurometabolites and magnetic resonance spectroscopy imaging (MRSI) signals in patients with refractory obsessive-compulsive disorder (OCD). MethodsFrom January 2018 to January 2020, 64 patients with OCD consecutively treated in the Psychiatric Department of our hospital were randomly divided into a study group treated with MECT and a control group treated with drugs alone. The obsessive-compulsive state, anxiety and depression, MRSI signals, neuro metabolite ratio, and quality of life were all observed in both groups. ResultsAfter treatment, the scores of compulsive behaviors, obsessive thoughts, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD) in the study group were lower than those of the control group. The N-acetylaspartate to creatine ratio (NAA/Cr) value was increased in the study group while it was decreased in the control group. In addition, the choline/creatine (Cho/Cr) ratio was decreased in the study group, whereas it was increased in the control group (P < 0.05). Compared to the control group, the study group's social and physiological functions, role limitations, and overall health scores were significantly higher. The amplitudes of low-frequency fluctuations were reduced considerably following MECT treatment in the right anterior cerebellar lobe, left inferior parietal lobule, right paracentral lobule, and right precentral gyrus. ConclusionsMECT can effectively relieve obsessive-compulsive symptoms, regulate neuro metabolite levels, improve quality of life, reduce anxiety and depression, and is linked to changes in right brain functional activities.

The Role of Magnetic Resonance Spectroscopy in Evaluating the Rate of Brain Metabolic Variations in Chemical Veterans with Respiratory Problem In Comparison To Control Group.

BACKGROUND:During the eight years of the imposed war, Iraq used various chemical agents such as sulfur mustard and nerve agents (mainly tabun and sometimes soman) on Iran’s soldiers. Using information obtained from specialist sequences and analysing information obtained from magnetic resonance imaging (MRI) in a susceptibility weighted imaging (SWI) sequence and magnetic resonance spectroscopy (MRS) provides valuable information on continuation of treatment and identifying functional disorders.AIM:The objective of this research was to evaluate the rate of metabolic variations in chemically injured veterans based on chemical neuromarkers using the chemical sequence MRS, which would help patients and physicians in terms of time, economics, and selection of appropriate therapeutic methods, so if the can physician can get complete information about the metabolic properties of the brain through paraclinical (especially MRI) tools before treatment, he might change his treatment program to reduce the complications caused by it.METHODOLOGY:In this research, 40 chemically injured veterans with brain dysfunction admitted to the screening centre for MRI with specialized MRS sequence participated. Accordingly, we examined the rate of brain metabolic variations about the level of neuromarkers and evaluated the relationship between the level of neuromarkers and brain damages.RESULTS:The results of this research revealed that while the demographic characteristics such as age of the two groups of chemically injured veterans and control was similar, only the median of the NAA/Cr (N-acetylaspartate to creatine ratio) ratio in PONS of chemically injured patients was significantly lower than that of the control group, and this ratio was similar in other parts of the brain in two groups. The results also showed that the ratio of NAA to total choline and Cr was similar in all parts of the brain in two groups.CONCLUSION:Based on the research results, using the MR (Magnetic Resonance) spectroscopy device and determination of the value and ratio of markers such as creatinine and N-acetylaspartate and choline, the brain injuries of chemically injured veterans can be examined. By conducting further studies and larger sample size, the brain damages in veterans can be diagnosed early, which would be a great contribution in their treatment.

N-Acetylaspartate-to-creatine ratio in twelve brain locations among healthy men and women with different levels of education

Brain bioenergetics could be affected by many intrinsic and extrinsic factors, yet no link has been established between markers of bioenergetics in specific brain regions and educational level. In this cross-sectional study, we evaluated N-acetylaspartate-to-creatine ratio (NAA/Cr), a biomarker of brain functionality, using multivoxel proton magnetic resonance spectroscopy in twelve brain locations among healthy volunteers (n = 51; 30 females; age 47.8 ± 16.3 years) who earned either a high school diploma (36 out of 51) or a college degree (15 out of 51). Hierarchical multiple regression analysis revealed that our model as a whole (including level of education as a predictor variable, and age and gender as control variables) explained significant percentage of the variance in the NAA/Cr levels at 8 out of 12 specific brain locations (P< 0.05). This was highlighted in left anterior mesial cortex where the model explained 63.1% of the variance in brain NAA/Cr, with education and age make significant contributions (72.6% and 48.5%, respectively) to our model (P< 0.05). Having superior brain N-acetylaspartate-to-creatine ratio appears to be related with higher education in healthy men and women.

Evaluation of cognitive functions of juvenile myoclonic epileptic patients by magnetic resonance spectroscopy and neuropsychiatric cognitive tests concurrently.

Our aim in this research is investigating the hypothesis of biochemical changes in frontal cortex and thalamocortical pathways in juvenile myoclonic epilepsy (JME) and the interaction between the biochemical changes and cortical functions. Magnetic resonance spectroscopy (MRS) was applied to 20 JME patients and 20 controls for measuring N-acetyl aspartate (NAA), N-acetyl aspartate to creatine ratio (NAA/Cr), Glutamine and Glutamate (GLX), Glutamine-Glutamate to creatine (GLX/Cr), Choline containing compounds (Cho) and Choline to creatine (Cho/Cr) levels. Neuropsychological cognitive tests for linguistic and visual attention, linguistic and visual memory, visuospatial and executive functions were applied to all participants. NAA and NAA/Cr concentrations were found lower in bilateral frontal and thalamic regions in JME group as compared with the control group (p<0.05). There was no difference in frontal and thalamic GLX, GLX/Cr, Cho, Cho/Cr levels in between JME patients and controls (p>0.05). JME patients were found more unsuccessful than the controls in attention, memory, visuospatial function, verbal fluency, Trail B test and executive functions, stroop test, clock drawing test and Trail A test (p<0.05). Prefrontal NAA/Cr level was positively related to visual attention, memory, stroop test and thalamic NAA/Cr level was positively related to linguistic memory and Wisconsin card sorting test in JME patients. This research highlights regional brain changes and cognitive decline in JME patients and suggests that MRS may be a sensitive technique for showing subclinical cognitive changes.

Diffuse Brain Abnormalities in Myotonic Dystrophy Type 1 Detected by 3.0 T Proton Magnetic Resonance Spectroscopy

Patients with myotonic dystrophy type 1 (DM1) (n = 14) were compared with healthy controls (n = 13) using 3.0 T proton magnetic resonance spectroscopy (¹H-MRS) to investigate brain pathophysiology. ¹H-MRS imaging revealed reduced N-acetylaspartate to creatine ratio (NAA/Cr) in multiple brain regions (average 24%), suggesting diffuse brain abnormalities among patients with DM1. Single-voxel ¹H-MRS among patients with DM1 showed (1) reduced NAA in both the frontal cortex (23%) and frontal white matter (31%) and unaltered myo-inositol, suggesting neuronal abnormalities without significant gliosis; and (2) elevated glutamine in the frontal cortex (36%) and reduced glutamate in the frontal white matter (20%) among patients with DM1, suggesting abnormalities in the glutamatergic system in the brain of patients with DM1. We consider that these results reflect brain abnormalities that cannot be detected by neuropathological assessment in patients with DM1.

Coeliac disease and neurological dysfunction: a case-control study

BackgroundPrevalence of neurological dysfunction in a prospective cohort of patients newly diagnosed with coeliac disease is yet to be determined. The spectrum of neurological deficit in patients with this disease remains unclear. We aimed to establish the prevalence of neurological deficit in patients newly diagnosed with coeliac disease and to compare the clinicoradiological features of this group with patients presenting with neurological changes that eventually led to diagnosis of the disorder. MethodsPatients with newly diagnosed coeliac disease recruited from a tertiary referral gastrointestinal clinic at the Sheffield Teaching Hospitals NHS Foundation Trust were prospectively reviewed by a neurologist and underwent MRI of the brain. Clinicoradiological features of patients who presented with neurological dysfunction to a tertiary referral neurological clinic and who were subsequently diagnosed with coeliac disease were retrospectively reviewed. MRI biomarkers—cerebellar volume (percentage ratio of cerebellar volume to total intracranial volume [%CV:TIV]); N-acetylaspartate to creatine ratio (NAA/Cr), a marker of neuronal health, measured with cerebellar proton MR spectroscopy; and voxel-based morphometry (VBM)—were analysed. Data were also compared with those of healthy volunteers who underwent the same MRI protocol and who were recruited from the local area. Regional ethics committee approved the study and all participants gave informed consent. Findings30 patients (mean age 47 years, SD 16, range 23–77; 12 men) with newly diagnosed coeliac disease were recruited. 20 patients (61 years, 10, 42–74, nine men) diagnosed with coeliac disease after initially presenting with neurological dysfunction (neurological dysfunction group) were reviewed. MRI data were obtained from a register of 55 healthy volunteers (41 years, 15, 20–77; 32 men). 11 patients (37%) with newly diagnosed coeliac disease had neurological deficits on clinical examination, ten with mild gait ataxia and one with peripheral neuropathy. 16 patients (80%) in the neurological dysfunction group had gait ataxia (nine mild, six moderate, one severe); four patients had peripheral sensory neuropathy. %CV:TIV and NAA/Cr were significantly reduced in the neurological dysfunction group compared with patients with newly diagnosed disease (mean %CV:TIV 7·5 [SD 1·5] vs 8·5 [0·8], 95% CI 0·24–1·76; p=0·01 and NAA/Cr 0·85 [0·13] vs 0·95 [0·07], 0·04–0·17; p=0·004). %CV:TIV and NAA/Cr were also significantly lower in the neurological dysfunction group than in healthy volunteers (mean %CV:TIV 7·5 [SD 1·5] vs 8·4 [1·2], 95% CI 0·05–1·83; p=0·039 and NAA/Cr 0·85 [0·13] vs 0·98 [0·09], 0·05–0·20; p=0·001). There was no significant difference in %CV:TIV or NAA/Cr between patients newly diagnosed with coeliac disease and healthy volunteers. Patients in the neurological dysfunction group showed multiple regions of reduced grey matter density, especially of the cerebellum but also involving supratentorial regions (p<0·05) compared with healthy volunteers. Patients newly diagnosed with coeliac disaese showed only modest reduction in grey matter in the cingulate gyrus (p<0·05). InterpretationOur results might not be generalisable because data were obtained from a tertiary referral centre. Moreover, analysis of the neurological dysfunction subgroup was retrospective. Nonetheless, to our knowledge this is the first study to attempt to provide a prevalence of neurological dysfunction prospectively in patients with coeliac disease while also examining MRI biomarkers of brain dysfunction. This study seems to show that a significant proportion of patients presenting with gastrointestinal symptoms who are diagnosed with coeliac disease already have some neurological dysfunction. The group of patients that present with neurological dysfunction are more severely affected. Serological testing for the disease should be incorporated into the investigation of patients with unexplained neurological symptoms. Increased awareness of the spectrum of neurological dysfunction in coeliac disease and close collaboration between neurologists and gastroenterologists might increase detection and prevent unnecessary delay to dietary treatment, which could lead to permanent neurological disability. FundingCoeliac UK, Bardhan Research & Education Trust.

Cortical N-acetyl aspartate is a predictor of long-term clinical disability in multiple sclerosis

Objective:To evaluate the prognostic value of the cortical N-acetyl aspartate to creatine ratio (NAA/Cr) in early relapsing-remitting multiple sclerosis (RRMS).Methods:Sixteen patients with newly diagnosed RRMS were studied by serial MRI and MR spectroscopic imaging (MRSI) once every 6 months for 24 months. Clinical examinations, including the expanded disability status scale (EDSS), were performed at baseline, month 24, and at year 7.Results:Baseline cortical NAA/Cr correlated inversely with EDSS at month 24 (r = −0·61, P < 0·05), and patients with EDSS ≧ 4 had a lower baseline cortical NAA/Cr compared to those with EDSS less than 4 (P < 0·05). Baseline cortical NAA/Cr also correlated inversely with EDSS at the 7-year follow-up (r = −0·56, P < 0·05), and patients with EDSS ≧ 4 had a lower baseline cortical NAA/Cr compared to those with EDSS less than 4 (P < 0·05).Baseline brain parenchymal fraction (BPF) correlated inversely with EDSS at month 24 (r = −0·61, P < 0·05), but not with EDSS at year 7.Discussion:Cortical NAA/Cr in early RRMS correlated with clinical disability after 2 and 7 years and may be used as a predictor of long-term disease outcome.

Proton magnetic resonance spectroscopy and cognition in patients with spastin mutations

The hereditary spastic paraplegias (HSP) are heterogeneous neurodegenerative disorders characterized by progressive spasticity and weakness in the lower limbs. Axonal loss in the long corticospinal tracts has been shown. Supraspinal symptoms and findings in the most common dominant HSP type, SPG4, support the theory that the disease also causes cerebral neuronal damage in specific parts of the brain. To investigate whether SPG4-HSP is associated with neuronal biochemical changes detectable on MR spectroscopy (MRS), single-voxel proton MRS of the brain was performed in eight subjects from four families with genetically confirmed SPG4-type HSP and eight healthy age-matched controls. Volumes of interest (VOI) were located in the frontal white matter and motor cortex. N-acetyl-aspartate-to-creatine ratio (NAA/Cr), N-acetyl-aspartate-to-choline (NAA/Cho), cholin to creatin (Cho/Cr) and myo-inositol-to-creatine (Ins/Cr) ratios were calculated for both locations. Neuropsychological tests were performed to support the neuroradiological findings. The Cho/Cr ratio in motor cortex (MC) of SPG4-HSP subjects was significantly lower than in controls. This reduction of the Cho/Cr ratio in SPG4 subjects was significantly associated with age-related verbal learning- and memory (CVLT) reduction. Our findings support involvement of motor cortex in SPG4-HSP. Proton MRS could be a useful tool for detecting metabolite abnormalities in areas of brain that appear normal on MRI. Cho/Cr ratio may be a marker of neurodegenerative process in SPG4-HSP.

Alzheimer Disease: Postmortem Neuropathologic Correlates of Antemortem1H MR Spectroscopy Metabolite Measurements1

To determine the neuropathologic correlates of antemortem hydrogen 1 ((1)H) magnetic resonance (MR) spectroscopy metabolite measurements in subjects with Alzheimer disease (AD)-type pathology. This study was approved by the institutional review board and was compliant with HIPAA regulations. Informed consent was obtained from each subject. The authors identified 54 subjects who underwent antemortem (1)H MR spectroscopy and were clinically healthy or had AD-type pathology with low to high likelihood of AD according to National Institute on Aging-Reagan neuropathologic criteria at autopsy. They investigated the associations between (1)H MR spectroscopy metabolite measurements and Braak neurofibrillary tangle stage (Braak stage), neuritic plaque score, and AD likelihood, with adjustments for subject age, subject sex, and time between (1)H MR spectroscopy and death. Decreases in N-acetylaspartate-to-creatine ratio, an index of neuronal integrity, and increases in myo-inositol-to-creatine ratio were associated with higher Braak stage, higher neuritic plaque score, and greater likelihood of AD. The N-acetylaspartate-to-myo-inositol ratio proved to be the strongest predictor of the pathologic likelihood of AD. The strongest association observed was that between N-acetylaspartate-to-myo-inositol ratio and Braak stage (R(N)(2) = 0.47, P < .001). Antemortem (1)H MR spectroscopy metabolite changes correlated with AD-type pathology seen at autopsy. The study findings validated (1)H MR spectroscopy metabolite measurements against the neuropathologic criteria for AD, and when combined with prior longitudinal (1)H MR spectroscopy findings, indicate that these measurements could be used as biomarkers for disease progression in clinical trials.

Diffuse metabolic changes in the brain of patients with familial amyloid polyneuropathy. A proton MRSI study

Objectives To assess brain metabolic abnormalities in patients with familial amyloid polyneuropathy (FAP) due to the transthyretin (TTR) gene mutations. Background The TTR-FAP has variable phenotypic expression, which includes abnormalities of the central nervous system (CNS). Several conventional MRI studies have shown brain abnormalities, probably secondary to amyloid accumulation in leptomeningeal and subarachnoid vessels. However, TTR-related amyloid deposits do not seem to significantly affect the brain parenchyma and a prominent CNS impairment is considered to be rare in TTR amyloidosis. Methods We performed proton MR spectroscopic imaging ( 1H-MRSI) in the central brain of four unrelated TTR-FAP patients with either minimal or no signs of neurological involvement and eight age- and sex-matched normal controls (NC). Metabolic changes were assessed in the entire volume of interest (VOI) and in the frontal, periventricular and posterior white matter (WM). Results Conventional MRI was normal in 2 patients and showed minimal WM lesions in the remaining 2 patients. 1H-MRSI showed N-acetylaspartate to creatine ratio (NAA/Cr) decreases in the central brain VOI in all TTR-FAP patients ( p < 0.005). These NAA/Cr decreases were homogeneous in all WM regions ( p < 0.05 for all). Conclusions 1H-MRSI findings suggest that diffuse metabolic changes, probably related to axonal damage, are present in brains of TTR-FAP patients even when they have no or minimal clinical and MRI signs of CNS involvement. The mechanism leading to sub-clinical metabolic brain changes needs to be identified.

Hippocampal metabolic abnormalities in mild cognitive impairment and Alzheimer's disease

Mild cognitive impairment (MCI) defines a group of otherwise healthy elderly subjects with a markedly elevated risk of developing Alzheimer's disease (AD). In the search for biomarkers of MCI, we assessed whether MCI shares neurochemical abnormalities with AD in areas affected early in the course of the disease. As a secondary study aim, we tested to what extent neurochemical findings reflect neuropsychological deficits. Proton spectroscopy was performed in 19 MCI patients, 18 AD patients and 22 age and gender matched controls (CON) within the parietal gray and white matter (PWM and PGM) and the hippocampus (HIP). The cognitive test battery used included measures compiled by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). The N-acetyl-aspartate to creatine ratio (NAA/Cr) was significantly reduced in the HIP of MCI and AD compared with CON ( p < 0.05). Only AD patients showed parietal abnormalities, namely significantly elevated myoinositol (mI/Cr and mI/NAA) in PGM, reduced NAA/Cr and elevated mI/NAA in PWM. MCI subjects were significantly impaired in categorical verbal fluency (VF) ( p < 0.001) and delayed verbal recall (DVR) ( p < 0.001). VF was positively correlated with hippocampal NAA/Cr ( p < 0.05) and parietal mI/NAA ( p < 0.05). In summary, this study demonstrates shared neurobiological hippocampal abnormalities in MCI and AD, whereas parietal lobe neurochemical profiles and functions were normal in MCI. Thus, biological evidence is provided that MCI represents a precursor stage of AD. Moreover, multivoxel 1H MRS may enable an objective staging of the neurodegenerative process underlying the age-dependent cognitive deficits eventually leading to dementia.

Evaluation of Efficacy of an Automated Single-Voxel Proton MRS Algorithm on a 3T System

To evaluate the efficacy of a fully automatic, single-voxel, proton MR spectroscopy algorithm on a 3.0T MR system. The PROBE/SVQ algorithm (GE Medical Systems) was evaluated on a General Electric (GE) Signa LX-3T system. Ten normal volunteers (female, 21.1+/-2.0 years old) participated in the study. Nine representative regions of interest were examined, namely, right and left frontal white matter; right and left parietal white matter; right and left basal ganglia; right and left dentate nucleus; and pons. The mean coefficients of variation in all regions for the N-acetyl-aspartate to creatine ratio (NAA/Cr), choline to creatine ratio (Cho/Cr), and choline to N-acetyl-aspartate ratio (Cho/NAA) were 10.2+/-2.4%, 11.4+/-3.2% and 12.6+/-1.4%, respectively. A fully automated spectroscopic examination under clinical setting utilizing the PROBE/SVQ algorithm appears to be a reliable method, extending the window of routine clinical assessment of brain metabolism.

Nipah virus encephalitis: serial MR study of an emerging disease.

To report the serial magnetic resonance (MR) imaging findings of the Nipah virus. Twelve patients underwent serial MR imaging. Eight patients were examined at the outbreak; 11, at 1 month; and seven, at 6 months. Contrast material-enhanced MR images, diffusion-weighted images, and single-voxel proton MR spectroscopic images were reviewed. Clinical and neurologic assessment, as well as analysis of the size, location, and appearance of brain lesions on MR images, were performed. During the outbreak, all eight patients had multiple small foci of high signal intensity within the white matter on T2-weighted images. In six patients, cortical and brain stem lesions were also detected, and five patients had diffusion-weighted MR imaging-depicted hyperintensities. One month after the outbreak, five patients had widespread tiny foci of high signal intensity on T1-weighted images, particularly in the cerebral cortex. Diffusion-weighted images showed decreased prominence or disappearance of lesions over time. There was no evidence of progression or relapse of the lesions at 6-month follow-up. MR spectroscopy depicted reduction in N-acetylaspartate-to-creatine ratio and elevation of choline-to-creatine ratios. The Nipah virus has findings unlike other viral encephalitides: small lesions that are primarily within the white matter, with transient punctate cortical hyperintensities on T1-weighted images.

Proton magnetic resonance spectroscopic imaging studies in patients with newly diagnosed partial epilepsy.

To assess whether the N-acetyl aspartate (NAA) to creatine ratio (NAA/Cr) is abnormally low at the onset of epilepsy and whether successful treatment of seizures with antiepileptic drugs is sufficient for normalization of NAA/Cr. Proton magnetic resonance spectroscopic imaging (1H-MRSI) was used to measure NAA/Cr in temporal lobes of eight patients with newly diagnosed epilepsy before or soon after starting medication. Six patients had follow-up 1H-MRSI examinations 7 months later. Clinical pattern of the seizures and the EEG findings suggested partial seizures in all and TLE in five patients. None of the patients had lesional epilepsy according to magnetic resonance imaging. Initial 1H-MRSI of the temporal lobes showed significantly low NAA/Cr values in five of eight patients. Five of six patients who had follow-up 1H-MRSI were seizure-free after using medication; the remaining patient did not take medication and continued to experience occasional auras. Wilcoxon rank sign comparison of NAA/Cr on initial 1H-MRSI examination and follow-up 1H-MRSIs showed no significant difference (Z = 135, p = 0.893, 2-tailed) for five seizure-free patients. Neuronal dysfunction is present at an early stage of the epileptic process. NAA/Cr recovery in seizure-free patients controlled with antiepileptic drugs is less evident, compared with successful surgical treatment. Thus, absence of seizures is not necessarily coupled with NAA/Cr improvement and observed variable response warrants further investigation.