Spektroskopia rezonansu magnetycznego protonów do przewidywania odpowiedzi na leki w epilepsji skroniowej: badanie oparte na definicji ILAE

OBJECTIVE: Approximately 30-40% of patients with mesial temporal lobe epilepsy (MTLE) develop drug resistance, yet conventional MRI measures lack sufficient accuracy for early identification of drug-resistant cases. Proton magnetic resonance spectroscopy (H-MRS), as a non-invasive technique, enables quantitative assessment of neurometabolic alterations in epileptogenic regions. We hypothesized H - MRS may assist in distinguish ASM responsiveness of newly diagnosed MTLE patients and aimed to establish clinically neuroimage actionable biomarkers. METHODS: This prospective study recruited 195 newly diagnosed MTLE patients (aged 15-65 years) meeting inclusion/exclusion criteria. Collected data included demographics, seizure characteristics, interictal epileptiform discharge (IED) distribution, and hippocampal N-acetylaspartate/(Choline+Creatine) [NAA/(Cho+Cr)] ratios. After follow-up, patients were classified as drug-responsive (Group I, n=80), drug-resistant (Group II, n=32), or undefined (Group III, n=30). Variables with univariate significance (p<0.1) - including age, duration of epilepsy, epilepsy frequency, IED distribution, hippocampal asymmetry indices (right-left AI, IED ipsilateral-contralateral AI) and NAA/(Cho+Cr) - underwent binary logistic regression analysis. RESULTS: Univariate analysis showed significant differences in right-left asymmetry index (-0.09±0.51 vs 0.16±0.34, p=0.02) and IED ipsilateral-contralateral asymmetry index (-0.04±0.32 vs 0.14±0.26, p=0.01) of hippocampal head between group II and group III, and differences in right-left asymmetry index of hippocampal tail between group I and group III(-0.04±0.32 vs 0.14±0.26, p=0.01). In multivariate logistic regression models (adjusting for variables with p < 0.1 in univariate analysis), only the right-left AI of the hippocampal tail remained statistical importance (Group I vs III: OR=6.97, p=0.049). Furthermore, age > 35 years, moderate seizure frequency, longer epilepsy duration, right-sided and bilateral IEDs were identified as significant independent predictors of drug resistance. CONCLUSION: The study suggested that hippocampal metabolism was more severely and extensively disrupted in drug-resistant MTLE. H-MRS may provide prognostic value for drug responsiveness in patients with newly diagnosed MTLE but further investigations are needed to validate these findings.