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Research ArticleAdult Brain

Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings

Z. Tan, X. Long, F. Tian, L. Huang, F. Xie and S. Li
American Journal of Neuroradiology February 2019, 40 (2) 245-252; DOI: https://doi.org/10.3174/ajnr.A5944
Z. Tan
aFrom the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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X. Long
aFrom the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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F. Tian
aFrom the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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L. Huang
aFrom the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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F. Xie
bRadiology (F.X.), Xiangya Hospital, Central South University, Changsha, China.
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S. Li
aFrom the Departments of Neurology (Z.T., X.L., F.T., L.H., S.L.)
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Abstract

BACKGROUND AND PURPOSE: Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel 1H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations.

MATERIALS AND METHODS: Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel 1H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed.

RESULTS: Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05).

CONCLUSIONS: Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.

ABBREVIATIONS:

FIAS
focal impaired awareness seizures
PGTCS
primary generalized tonic-clonic seizures
SGTCS
secondary generalized tonic-clonic seizures
  • © 2019 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 40 (2)
American Journal of Neuroradiology
Vol. 40, Issue 2
1 Feb 2019
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Cite this article
Z. Tan, X. Long, F. Tian, L. Huang, F. Xie, S. Li
Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings
American Journal of Neuroradiology Feb 2019, 40 (2) 245-252; DOI: 10.3174/ajnr.A5944

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Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings
Z. Tan, X. Long, F. Tian, L. Huang, F. Xie, S. Li
American Journal of Neuroradiology Feb 2019, 40 (2) 245-252; DOI: 10.3174/ajnr.A5944
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