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Magnetic Resonance Spectroscopy
Use in Monitoring MELAS Treatment
Steven G. Pavlakis, MD;
Peter B. Kingsley, PhD;
Gary P. Kaplan, MD, PhD;
Peter W. Stacpoole, MD, PhD;
Michael O'Shea, MEE;
Dana Lustbader, MD
Arch Neurol. 1998;55:849-852.
Background Sodium dichloroacetate has been used to treat patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS). Magnetic resonance spectroscopy (MRS) has been used to assess cerebral metabolism in MELAS, but to our knowledge, the findings of serial MRS studies performed after therapeutic intervention of strokelike episodes have not been reported.
Methods Proton MRS was serially used to measure brain metabolites in strokelike regions and in clinically uninvolved brain regions in a patient with MELAS.
Patient A patient with MELAS and a strokelike episode clinically improved after treatment with sodium dichloroacetate. An elevated lactate-creatine ratio in the "stroke" region decreased on MRS studies after treatment. After a second episode, the lactate-creatine ratio increased from baseline in a region of the brain that was normal on magnetic resonance imaging scans.
Conclusions To our knowledge, this is the first study to assess the response to treatment of a MELAS strokelike episode and the first to show an increase in the lactate-creatine ratio in a brain region that was associated with a clinical abnormality, even though it appeared normal on magnetic resonance imaging. We conclude that MRS may help to monitor therapeutic efficacy in mitochondrial encephalomyopathies.
From the Departments of Neurology (Drs Pavlakis and Kaplan), Radiology (Dr Kingsley and Mr O'Shea), Medicine (Dr Lustbader), and Pediatrics (Dr Pavlakis), North Shore University Hospital, Manhasset, NY, and New York University, New York, NY, and the Department of Medicine (Division of Endocrinology and Metabolism), University of Florida, College of Medicine, Gainesville (Dr Stacpoole).
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