Proton magnetic resonance spectroscopy study of bilateral thalamus in juvenile myoclonic epilepsy

Purpose: To investigate neuronal dysfunction in the thalami of juvenile myoclonic epilepsy (JME) by using proton magnetic resonance spectroscopy (MRS). Methods: We performed single-voxel proton MRS over the right and the left thalami of 15 consecutive patients (10 women, 5 men) with JME (mean age 20.3 years) and 16 healthy volunteers (10 women, 6 men) (mean age 24.5 years). All patients had seizure onset in late childhood-teenage, normal neurologic examination, typical electroencephalogram (EEG) of JME and normal magnetic resonance imaging (MRI). We determined N-acetylaspartate (NAA) values and NAA over creatine-phosphocreatine (Cr) values. Mann-Whitney U-test was used to evaluate group differences. Results: Group analysis showed that echo time (TE) 270 integral value of NAA over left thalamus were significantly decreased in JME patients as compared with controls (34.6033 +/- 15.8386; 48.0362 +/- 22.2407, respectively, P = 0.019). Also group analysis showed that thalami NAA/Cr ratios were significantly decreased in JME patients (right side, 2.21 +/- 1.07; left side 2.00 +/- 0.72) as compared with controls (right side, 3.45 +/- 1.50; left side, 3.08. +/- 1.60; P = 0.011 and P = 0.030, respectively). Conclusion: In the previous studies, NAA values inpatients with JME found that they were not statistically lower in thalami than control group. But, in our study, NAA value was found tow as well. It has been known that NAA is a neuronal marker and hence it is a valuable metabolite in the neuron physiopathology. As a result, in the patients with JME we tried to support the theory that the underlying mechanism of the generalized seizures was the abnormal thalamocortical circuity, determining the thalamic neuronal dysfunction in MRS statistically.