Nuclear Magnetic Resonance Imaging, a New Approach to the Investigation of Refractory Temporal Lobe Epilepsy

La résonance magnétique nucléaire est une technique non invasive d'imagerie cérébrale utilisant les signaux produits par des champs magnétiques et des radioondes. 16 patients présentant une épilepsie due lobe temporal (TLE) réfractaire ont eu une imagerie par résonance magnétique (MRI) pendant leur exploration en vue d'un traitement chirurgical éventuel. Ces images et celles de 10 contrôles normaux ont été interprétés à l'aveugle, et les résultats des patients TLE ont été comparés aux données de l'EEG et du scanner. 14 patients, comparativement aux sujets normaux, avaient l'une ou plus d'une des modifications suivantes: petit lobe temporal, structures temporales mésiales petites, petit hémisphère, temps de relaxation “spin‐spin” prolongé dans la partie mésiale du lobe temporal. Ces données étaient positivement corrélées au siége du foyer EEG chez 11 patients. Des cornes temporales élargies ou asymétriques ont été trouvées avec une égale fréquence chez les patients et chez les contrôles et n‘étaient pas corrélées avec le siége du foyer EEG. Les scanners montrent moins ces modifications que la MRI. Les corrélations entre les modifications de la MRI et l'histopathologie des lobes temporaux réséqués étaient faibles. La MRI révèle des altérations structurelles et de probables altérations fonctionnelles qui peuvent aider à la localisation d'un foyer épileptogène dans le lobe temporal de patients présentant des crises partielles complexes rebelles au traitement médicamenteux.

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