1H MRSI predicts surgical outcome in MRI-negative temporal lobe epilepsy

H-1 MRS imaging (MRSI) was performed on 15 patients with MRI-negative temporal lobe epilepsy (TLE) who underwent seizure surgery. The non-seizure-free patients (NSF) ipsilateral hippocampal N-acetylaspartate (NAA)/(Cr+Cho) z scores were lower than the contralateral scores (p=0.04), and the NSF ipsilateral z scores were lower than the seizure-free patients' (SF) ipsilateral z scores (p=0.0049). Similarly, NSF contralateral scores were lower than contralateral SF (p=0.02). These findings suggest NAA predicts the surgical outcome-in patients with TLE without evidence of mesial temporal sclerosis on MRI.