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Surgical Outcome and Focal Hippocampal Changes Revealed by Proton Magnetic Resonance Spectroscopy Imaging

Michael Feichtinger, MD; Elisabeth Pauli, PhD; Iris Schäfer; Knut W. Eberhardt, MD; Bernd Tomandl, MD; Johannes Huk, MD; Hermann Stefan, MD

Arch Neurol. 2001;58:771-777.

Background  Ictal fear (IF) is most frequently associated with epileptic discharges from mesial temporal areas.

Objectives  To determine whether patients with IF were more likely to become seizure free after anteromesial temporal lobe resection compared with those without IF and whether they show more anteriorly pronounced metabolic changes assessed by means of multivoxel magnetic resonance spectroscopy (MRS) along the hippocampal axis.

Methods  Surgical outcome was assessed in 33 consecutive patients with temporal lobe epilepsy after a mean follow-up of 25 months (range, 12-38 months). Proton multivoxel MRS of the hippocampal formation was applied to detect regional differences along the axis of the hippocampus in patients with and without IF. Magnetic resonance tomography showed typical features of hippocampal sclerosis in all patients.

Results  Twelve (36%) of the 33 patients reported fear at the beginning of their habitual seizures. Eleven of these patients were seizure free postoperatively. In contrast, only 11 of 21 patients without IF had a favorable outcome. Results of MRS revealed significantly higher pathologic N-acetylaspartate–choline ratios in the anterior portion of the hippocampal formation in patients with than in those without IF, indicating focal metabolic and/or morphologic changes in the head of the hippocampus.

Conclusions  These results indicate the importance of diagnosing auras with IF to provide a more detailed prognosis of the surgical outcome. In addition, our data emphasize that multivoxel MRS is a valuable tool in the presurgical evaluation, as it may reveal different topographical patterns of hippocampal sclerosis.

From the Department of Neurology, University Erlangen–Nuremberg, Erlangen, Germany.

Corresponding author and reprints: Hermann Stefan, MD, Department of Neurology, University Erlangen–Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany (e-mail: hermann.stefan{at}neuro.med.uni-erlangen.de).

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