质子磁共振波谱和长程脑电图对颞叶癫痫的评估作用比较

Evaluation of proton magnetic resonance spectroscopy versus longterm electroenciphalogram for temporal lobe epilepsy

目的:探讨质子磁共振波谱分析和脑电图监测对颞叶癫痫病灶定侧的判定价值。方法:选择12例颞叶癫痫患者为观察对象,为苏州大学附属第一医院2003-01/12收治。分别采样双侧近中颞叶质子磁共振波谱,对氮-乙酰天冬氨酸、肌酸、胆碱复合物进行半定量分析,以氮-乙酰天冬氨酸减少/或肌酸+胆碱复合物的增加以及其比值下降定侧判断癫痫灶。所有病例均做长程脑电图监测。结果:按意向处理分析,12例患者均完成了测试。①10例显示一侧氮-乙酰天冬氨酸/(肌酸+胆碱复合物)<0.68,并与对侧差别>7%,可以定侧。②脑电图异常9例,其中8例为单侧异常,1例双侧异常。③8例质子磁共振波谱和脑电图定侧一致。脑电图阴性3例中2例质子磁共振波谱可以定侧。结论:质子磁共振波谱在颞叶癫痫定侧诊断方面有较高的敏感性,与脑电图结合可提高定侧诊断的可靠性。

AIM:To study the role of proton magnetic resonance spectroscopy and electroenciphalogram in diagnosis of temporal lobe epilepsy.METHODS:A total of 12 patients with temporal lobe epilepsy were selected from First Affiliated Hospital of Suzhou University from January to December 2001.Proton magnetic resonance spectroscopy was obtained from bilateral medial temporal lobes for semquantitative analysis of Nacetylaspartic acid,creatine and choline compounds.The decreased Nacetylaspartic acid and/or the increasrf creatine+choline compounds and the decreased odd were used to judge epilepsy focus.RESULTS:According to intentiontotreat,all 12 persons finished the experiment.①Ten patients showed the Nacetylaspartic acid/(creatine and choline compounds) ratio was < 0.68 in unilateral temporal lobe and the side to side difference for two temporal lobes was >7%,so we could make lateralization diagnosis.②Nine patients showed abnormal electroenciphalogram,among whom,eight were abnormal in unilateral electroenciphalogram,and one was abnormal in bilateral ones.③Proton magnetic resonance spectroscopy and electroenciphalogram showed consistency in 8 cases.Proton magnetic resonance spectroscopy in two of three with negative electroenciphalogram could make lateralization diagnosis.CONCLUSION:Proton magnetic resonance spectroscopy is highly sensitive to lateralization diagnosis of temporal lobe epilepsy and can enhance the reliability of lateralization diagnosis combined with the electroenciphalogram.