Abstracts

This Proton Magnetic Resonance Spectroscopic Imaging (¹H MRSI) study measured extratemporal metabolites in pediatric epilepsy and related them to seizure variables and to psychiatric and cognitive comorbidities, an underexplored area., Thirteen children and adolescents with epilepsy were compared to 13 age- and gender-yoked healthy controls. All subjects underwent structured psychiatric diagnostic interviews and IQ testing. Long echo-time 1.5-T MRSI sampled basal gangliar, ventricular, and supraventricular brain. CSF-corrected levels and ratios were calculated for N-acetyl compounds (NAA), creatine+phosphocreatine (Cr), and choline-compounds (Cho)., In the epilepsy subjects, parietal cortex NAA/Cr (bilateral) and NAA/(Cr+Cho) (left-side) were below-normal, especially in those with cryptogenic complex partial seizures (9 subjects). Cho was above-normal in bilateral anterior middle cingulate and striatum (left caudate body, bilateral putamen). Cho/Cr was elevated in right caudate head. NAA/Cr in right parietal cortex correlated positively with verbal IQ (VIQ). Cho was higher in subjects with a history of febrile seizures (right putamen) or current attention-deficit hyperactivity disorder diagnosis (ADHD; left putamen). Cho correlated negatively with VIQ in right anterior middle cingulate and left putamen., Low NAA/Cr, NAA/(Cr+Cho) and high Cho are frequently seen in epilepsy. In pediatric epilepsy, our preliminary findings suggest parietal cortex, anterior middle cingulate cortex, and striatum as vulnerable extratemporal sites for these metabolic abnormalities. Pathophysiology in these regions may reflect low neuron density or activity, elevated glial density or activity, or disturbed membrane or energetic metabolism and contribute to ADHD and diminished verbal skills in children with epilepsy.[figure1], (Supported by NIH grants NS32070 and MH067187 (R.C.).)