Multi-voxel magnetic resonance spectroscopy at 3 T in patients with idiopathic generalised epilepsy

Purpose: The objective of our study was to gain further insight into the extent of local metabolic alterations in patients with idiopathic generalised epilepsy (ICE), respectively, the subgroup with generalised tonic-clonic seizures (GTCS). The extent of regional metabolic involvement perhaps indicates the key structures in generation of seizures and involvement of specific network of dysfunction. Methods: Using the multi-voxel technique at a 3 T MRI Scanner metabolite levels of 25 age-matched healthy controls and 18 patients with GTCS were obtained from the basal ganglia, insular cortex, cingulum, hippocampus and along both hemispheres in the fronto-parietal white and grey matter. Results: Group analysis of GTCS patients versus healthy controls revealed significant (p < 0.05) decrease of tNAA in the cortex of the central region and cingulum, but also in the thalami. Glx was elevated broadly in both hemispheres, in particular in central region, cingulum, insular cortex and left putamen, yet also in the right thalamus. Cho and ml demonstrated a significant coincidental decrease pronounced in the grey and white matter of the central region. Significant metabolic correlation (p <= 0.05) based on tNAA, respectively, Glx occurred between the thalamus and the central region, cingulum, putamen and medial frontal cortex. In patients with >2 tonic-clonic seizures in the last 12 months a trend towards higher Glx and lower tNAA levels was observed. Discussion: Our results demonstrate the altered metabolic interconnection of cerebral anatomic regions in patients with GTCS, in particular the major role of basal ganglia-central region relay in seizure generation. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.