MR Spectroscopy and EEG- Predictive Value of Outcome in Neonates with Hypoxic Ischemic Encephalopathy
Abstract number :
2.202
Submission category :
Year :
2001
Submission ID :
3071
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
L. Gabis, MD, Neurology, SUNY Stony Brook, Stony Brook, NY; M. Andriola, MD, Neurology, SUNY Stony Brook, Stony Brook, NY; W. Huang, PhD, Radiology, SUNY Stony Brook, Stony Brook, NY; A. Spitzer, MD, Pediatrics, SUNY Stony Brook, Stony Brook, NY
RATIONALE: In this study, we sought to determine the capability of EEG and MRS to detect predict outcome in neonates with Hypoxic Ischemic Encephalopathy (HIE).
METHODS: Six infants were studied during their first week of life using clinical assessment, prolonged EEG and neuroimaging. All infants suffered from HIE and had abnormal neurological exam and seizures. EEG was done with neonatal montage. Single voxel 1H MRS was performed with voxels placed in areas of normal appearing white and gray matter in 5 infants and a multivoxel analysis was done in one infant. We calculated ratios of N-Acetyl-Aspartate (NAA), creatine, choline and lactate to each other.
RESULTS: EEG and H1 MR Spectroscopy (MRS) were abnormal in all patients. The predominant EEG pattern during first week of life showed burst suppression pattern in two patients, severe attenuation in two patients and multifocal spikes in two patients. The pattern of EEG abnormality correlated with the occurrence of seizures and with the neurological exam during first week of life. Abnormal EEG predicted future neurologic impairment but was unable to predict the degree of subsequent deficits or the need for long term antiepileptic treatment. The initial MRS of the infants with HIE showed different degrees of NAA reduction and elevated lactate, lipid and choline peaks. As shown in prior studies, a ratio of lactate to NAA more than one correlated with adverse outcome. The degree of NAA reduction and lactate and choline elevation correlated with the degree of impairment.
CONCLUSIONS: Abnormalities on EEG provide information about present brain function and future neurologic impairment in infants with HIE. MRS findings of low NAA and high lactate (lactate/ NAA ratio more than 1) indicate severe neuronal dysfunction and predict abnormal neurological outcome in infants with HIE. MRS provides early quantitative information that may add to the qualitative neurologic exam and EEG findings. MRS analysis has a prognostic value in infants. Early use of EEG and neuroimaging may provide tools for monitoring interventions in infants with HIE.
Support: Study not funded.