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Brain Advance Access published online on April 6, 2004
Brain, doi:10.1093/brain/awh157
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© 2004 The Guarantors of Brain

Article

Longitudinal study of MRS metabolites in Rasmussen encephalitis

R. M. Wellard 1, R. S. Briellmann 2, J. C. Wilson 3, R. M. Kalnins 1, D. P. Anderson 4, P. Federico 1, G. C. A. Fabinyi 1, I. E. Scheffer 5, A. S. Harvey 1, and G. D. Jackson 2*

1 Brain Research Institute, Heidelberg West 3081, Australia
2 Brain Research Institute, Heidelberg West 3081, and University of Melbourne, Parkville, Australia
3 Institute for Glycomics, Griffith University (Gold Coast Campus), Queensland, Australia
4 Brain Research Institute, Heidelberg West 3081 and Brain Sciences Institute, Swinburn University of Technology, Hawthorn, Victoria, Australia
5 Epilepsy Research Institute, Heidelberg West 3081, and University of Melbourne, Parkville, Australia

* Corresponding author. E-mail: g.jackson{at}brain.org.au.

Received 29 October 2003 ; revised 16 January 2004 ; accepted 19 January 2004

Abstract

This study analyses the evolution of metabolite changes in an 8-year-old boy with focal Rasmussen encephalitis. Five MRI examinations, including magnetic resonance spectroscopy (MRS) were performed over 9 months. Following complex partial status, T2-weighted imaging showed transient dramatic signal increase in the left superior temporal gyrus and mesial temporal structures. Subsequent scans showed resolution of the swelling and signal normalization, with development of slight focal atrophy. MRS after status showed a reduction in N-acetylaspartate, total creatine and trimethylamines. Subsequent scans showed complete resolution of these metabolite abnormalities, followed later by development of further abnormal metabolite values. Lactate and glutamine/glutamate were elevated after status. After surgery, ex vivo high-field 1H and 31P MRS confirmed metabolite abnormalities (elevated choline and decreased aspartate, N-acetylaspartate, [1H]glutamate together with altered [31P]phospholipid ratios. These findings suggested active disease process in the anterior region of the excised superior temporal gyrus. We conclude that Rasmussen encephalitis is a combination of progressive encephalitic damage and fluctuating seizure effects, in which neuronal injury and recovery can occur. MRS measurements at a single time point should consider the fluctuating metabolite profile related to seizure activity.

Keywords: Rasmussen; chronic localized encephalitis; epilepsy; magnetic resonance spectroscopy; MRS
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