Proton MR spectroscopy in patients with sleep-related hypermotor epilepsy (SHE): Evidence of altered cingulate cortex metabolism

Ilaria Naldi, Francesca Bisulli, Claudia Testa, Giovanni Rizzo, Lorenzo Ferri, Laura L. Gramegna, Laura Licchetta, Raffaele Lodi, Caterina Tonon, Paolo Tinuper

Research output: Contribution to journalArticle

Abstract

Study Objectives: To identify structural and/or metabolic alterations in patients with sleep-related hypermotor epilepsy (SHE) using magnetic resonance imaging (MRI) and proton MR spectroscopy (1H-MRS). Methods: Nineteen SHE patients (seven males; 34.7 ± 9.7 years, mean age ± standard deviation) and 17 matched healthy volunteers (seven males; 34.0 ± 8.9 years) were included in the study. In all patients, the diagnosis of SHE was confirmed by video-polysomnographic recording of seizures. Semiology, seizure frequency, and therapy were assessed for all patients. For each recruited participant, structural MRI and 1H-MRS sequences were acquired. 1H-MRS was performed on two regions of interest: the medial thalamus and the anterior cingulate gyrus. Results: At examination, five patients were seizure free. In the remainder, seizure frequency ranged from yearly to multiple episodes per night. Brain MRI was normal in all patients but one. The ratio of N-acetyl-aspartate/Creatine (NAA/Cr) was significantly reduced in the anterior cingulate cortex in patients compared to controls (p < .05). Thalamic NAA/Cr showed no differences between patients and controls. Regression analysis showed that NAA/Cr in the anterior cingulate gyrus correlated with seizure frequency (p < .05), being lower in patients with higher seizure frequency. Conclusions: Given the absence of structural MR changes, our 1H-MRS data point to a functional NAA reduction in the cingulate cortex of SHE patients, more severe in those patients with higher seizure frequency and thus supporting the involvement of the anterior mesial structures in the pathophysiology of SHE.

Original languageEnglish
Article numberzsx115
JournalSleep
Volume40
Issue number9
DOIs
Publication statusPublished - 2017

Fingerprint

Gyrus Cinguli
Protons
Epilepsy
Sleep
Magnetic Resonance Spectroscopy
Seizures
Creatine
Magnetic Resonance Imaging
Matrix Attachment Regions
Video Recording
Thalamus
Healthy Volunteers
Regression Analysis

Keywords

  • H-MRS
  • Cingulate gyrus
  • Epilepsy
  • Neuroimaging
  • Sleep-related Hypermotor Epilepsy
  • Vocturnal frontal lobe epilepsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Physiology (medical)

Cite this

Proton MR spectroscopy in patients with sleep-related hypermotor epilepsy (SHE) : Evidence of altered cingulate cortex metabolism. / Naldi, Ilaria; Bisulli, Francesca; Testa, Claudia; Rizzo, Giovanni; Ferri, Lorenzo; Gramegna, Laura L.; Licchetta, Laura; Lodi, Raffaele; Tonon, Caterina; Tinuper, Paolo.

In: Sleep, Vol. 40, No. 9, zsx115, 2017.

Research output: Contribution to journalArticle

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AU - Naldi, Ilaria

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AU - Testa, Claudia

AU - Rizzo, Giovanni

AU - Ferri, Lorenzo

AU - Gramegna, Laura L.

AU - Licchetta, Laura

AU - Lodi, Raffaele

AU - Tonon, Caterina

AU - Tinuper, Paolo

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N2 - Study Objectives: To identify structural and/or metabolic alterations in patients with sleep-related hypermotor epilepsy (SHE) using magnetic resonance imaging (MRI) and proton MR spectroscopy (1H-MRS). Methods: Nineteen SHE patients (seven males; 34.7 ± 9.7 years, mean age ± standard deviation) and 17 matched healthy volunteers (seven males; 34.0 ± 8.9 years) were included in the study. In all patients, the diagnosis of SHE was confirmed by video-polysomnographic recording of seizures. Semiology, seizure frequency, and therapy were assessed for all patients. For each recruited participant, structural MRI and 1H-MRS sequences were acquired. 1H-MRS was performed on two regions of interest: the medial thalamus and the anterior cingulate gyrus. Results: At examination, five patients were seizure free. In the remainder, seizure frequency ranged from yearly to multiple episodes per night. Brain MRI was normal in all patients but one. The ratio of N-acetyl-aspartate/Creatine (NAA/Cr) was significantly reduced in the anterior cingulate cortex in patients compared to controls (p < .05). Thalamic NAA/Cr showed no differences between patients and controls. Regression analysis showed that NAA/Cr in the anterior cingulate gyrus correlated with seizure frequency (p < .05), being lower in patients with higher seizure frequency. Conclusions: Given the absence of structural MR changes, our 1H-MRS data point to a functional NAA reduction in the cingulate cortex of SHE patients, more severe in those patients with higher seizure frequency and thus supporting the involvement of the anterior mesial structures in the pathophysiology of SHE.

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