Article Figures & Data
Figures
- Fig 1.
Voxel-of-interest (inner 8 × 8 matrix) and masked region (7 × 7 matrix) that retained spectra based on SNR, NAA, and adequate Cramér-Rao bounds. Across the brain (spectra labeled A–F, corresponding to labeled voxels in image at the upper right), 2 peaks comprising lactate and BHB are shown at 1.33 and 1.2 ppm, respectively, with lactate more prominent in voxels containing CSF in this patient with mitochondrial cytopathy. At the lower right, the composite spectrum from the masked region is shown, with the LCModel fit overlaid.
- Fig 2.
Scatterplot of blood serum BHB concentrations (milligrams/deciliter) versus brain BHB/NAA and BHB/Cr ratios demonstrates the strong associations between measures.
Tables
- Table 1:
Patient clinical data including underlying epilepsy syndrome, seizure type, and antiepileptic medications
Patient Age (yr) Epilepsy Syndrome21–23 Seizure Type Medications 1 1 EE (Unclassified) T LEV 2 2 Metabolic (Mito) TS ZNS/LTG/LEV 2 7 Metabolic (Mito) TS/GTC ZNS/LTG/LEV/RFM 2 8 Metabolic (Mito) TS/MY/GTC ZNS/LTG/LEV/RFM 3 9 MAE MY/AT/GTC VPA/CLB/RFM 4 7 Metabolic (Mito) MY/RFL TPM 4 10 Metabolic (Mito) MY/RFL TPM/ZNS 5 7 EE (MCD) T/AT/TS VGB/LTG 6 2 Structural (MCD) Focal ZNS/TPM 7 1 Structural (Aicardi) ES VGB 8 6 Genetic (SCN1A) MY/AT LEV/ETX/CLN 9 6 Metabolic (Mito) MY/AT LEV/LTG/ETX/CLN 10 6 MAE T/MY/TS LTG 11 0.5 Genetic (ATP1A3) Focal/SE LEV 11 1 Genetic (ATP1A3) SUB/MY LTG/CLB 12 6 EE (unclassified) AT/T/GTC CLB 13 1 EE (unclassified) ES VGB 14 2 Metabolic (Mito) ES TPM 15 4 EE (LGS) AT/T/AA LTG/LEV/ZNS 16 1 EE (Unclassified) ES ZNS/LEV 17 5 Genetic (DEAF 1) T/AT/GTC LEV 18 1 Metabolic (Mito) ES ZNS Note:—“Epilepsy Syndrome”: EE indicates epileptic encephalopathy; Mito, primary mitochondrial disease; MAE, myoclonic astatic epilepsy; MCD, malformation of cortical development; LGS, Lennox-Gastaut Syndrome; “Seizure Type”: T, tonic; TS, tonic spasms; GTC, generalized tonic-clonic; MY, myoclonic; AT, atonic; RFL, reflexive seizure; ES, epileptic spasms; SE, status epilepticus; AA, atypical absence; SUB, subclinical seizures; “Medications”: LEV, levetiracetam; ZNS, zonisamide; LTG, lamotrigine; RFM, rufinamide; CLB, clobazam; TPM, topiramate; VGB, vigabatrin; ETX, ethosuximide; CLN, clonazepam; VPA, valproic acid.
- Table 2:
Partial correlations of blood BHB concentration (mg/dL) and brain metabolite ratios derived from 1H-MRS, using patient age in months as a covariate
Group BHB/Cr BHB/Cho BHB/NAA BHB/Lac Cho/Cr NAA/Cr NAA/Cho Lac/NAA Lac/Cr Lag ≤14 d (n = 13) R .871 .898 .886 .507 −.287 −.645 −.540 .376 .253 Significance .000 .000 .000 .092 .367 .024 .070 .228 .428 Lag ≤30 d (n = 23) R .803 .814 .807 .538 −.165 −.553 −.443 .421 .334 Significance .000 .000 .000 .010 .463 .008 .039 .051 .128 Lag ≤120 d (n = 31) R .790 .802 .781 .484 −.312 −.658 −.515 .523 .423 Significance .000 .000 .000 .008 .099 .000 .004 .004 .022 All (N = 49) R .579 .588 .584 .393 −.170 −.387 −.312 .290 .162 Significance .000 .000 .000 .006 .254 .007 .033 .048 .278 Note:—Lac indicates lactate.
