1H MR spectroscopy in histopathological subgroups of mesial temporal lobe epilepsy.

The aim of the study was to analyze the lateralizing value of proton magnetic resonance spectroscopy ((1)H MRS) in histopathologically different subgroups of mesial temporal lobe epilepsies (MTLE) and to correlate results with clinical, MRI and seizure outcome data. A group of 35 patients who underwent resective epilepsy surgery was retrospectively studied. Hippocampal (1)H MR spectra were evaluated. Metabolite concentrations were obtained using LCModel and NAA/Cr, NAA/Cho, NAA/(Cr+Cho), Cho/Cr ratios and coefficients of asymmetry were calculated. MRI correctly lateralized 89% of subjects and (1)H MRS 83%. MRI together with (1)H MRS correctly lateralized 100% of patients. Nineteen subjects had "classical" hippocampal sclerosis (HS), whereas the remaining 16 patients had "mild" HS. Nineteen patients had histopathologically proven malformation of cortical development (MCD) in the temporal pole; 16 subjects had only HS. No difference in (1)H MRS findings was found between patients in different histopathological subgroups of MTLE. Our results support the hypothesis that (1)H MRS abnormalities do not directly reflect histopathological changes in MTLE patients. Subjects with non-lateralized (1)H MRS abnormalities did not have a worse postoperative seizure outcome. We found no significant impact of contralateral (1)H MRS abnormality on post-surgical seizure outcome.