Proton magnetic resonance spectroscopy in children with some neurological and mental disorders accompanied by mental and speech development delay: a prospective study

Abstract

INTRODUCTION: Despite the development and introduction of new neuroimaging methods into clinical practice, the proton magnetic resonance spectroscopy method has still not found wide application. This is hampered by various technical, methodological and organizational problems. On the other hand, there is no information about the clinical possibilities of proton magnetic resonance spectroscopy in the diagnosis of children with mental and speech retardation, assessment of their dynamics, and features of metabolic changes in the central nervous system. Due to the advent of new proton magnetic resonance spectroscopic techniques that allow the use of multivoxel volumes of the studied tissues, it has become possible to assess the role and place of proton magnetic resonance spectroscopy in children with similar manifestations.OBJECTIVE: The study was to study the relationship between the complex of acetylaspartate and choline metabolism in the brain in children with neurological and mental disorders accompanied by a delay in mental and speech development.MATERIALS AND METHODS: 102 patients were examined, of which: 30 children (29.4%) were with atypical autism and mental retardation; 22 patients (21.5%) with focal temporal epilepsy and delayed speech development; 18 children (17.8%) with focal temporal epilepsy and without delayed speech development; 13 patients (12.7%) with cognitive epileptiform disintegration; 19 children (18.6%) without CNS pathology were included in the comparison group. The age of the examined varied from 2 to 10 years, the average age was 4.9±2.0 years.Statistics: The analysis included determining the numerical characteristics of the variables and checking the normality of the distribution of values. Methods of parametric and nonparametric statistics were used. For parametric statistics, a standard analysis using the Student’s t-test was used. From the methods of nonparametric statistics, methods of correlation analysis with calculation of the Mann-Whitney U-test coefficient were used. The results were considered reliable at p<0.05.RESULTS: In the brain of children with atypical autism and mental retardation, the following changes were revealed: in the prefrontal cortex, on both sides, a decrease in the ratio of NAA/Cr concentrations, an increase in Cho/Cr and Cho/NAA (p<0.05); in the postcentral gyrus area, on both sides, a decrease in the ratio of NAA/Cr concentrations (p<0.05); in the area of the inner capsule, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05); in the area of the temporal lobes, on both sides, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05); in the area of the hippocampus, on both sides, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05). In patients with temporal epilepsy and delayed speech development, the following changes were revealed: in the prefrontal cortex on both sides, an increase in the ratio of Cho/Cr concentrations (p<0.05); in the area of the postcentral gyrus, a decrease in the ratio of NAA/Cr concentrations on the right and an increase in Cho/Cr on both sides (p<0.05); in the area of the inner capsule on both sides, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05); in the area of the temporal lobes, a decrease in the ratio of NAA/Cr concentrations is observed on the right and an increase in Cho/Cr (p<0.05); in the hippocampal region on both sides there is a decrease in the ratio of NAA/Cr concentrations, an increase in Cho/Cr and Cho/NAA (p<0.05). In children with focal temporal epilepsy without delayed speech development, the following changes were revealed: in the temporal lobe area on the right, a decrease in the ratio of NAA/Cr concentrations (p<0.05); in the hippocampus area on the right, a decrease in the ratio of NAA/Cr concentrations and an increase in Cho/Cr (p<0.05). In children with cognitive epileptiform disintegration, the following changes were revealed: in the prefrontal cortex, on both sides, an increase in the Cho/Cr concentration ratio (p<0.05); in the postcentral gyrus area, on both sides, an increase in the Cho/Cr concentration ratio (p<0.05); in the area of the inner capsule, on both sides, an increase in the ratio of Cho/Cr concentrations (p<0.05); in the area of the temporal lobes, on both sides, a decrease in the ratio of NAA/Cr concentrations, an increase in Cho/Cr and Cho/NAA (p<0.05); in the hippocampal region, on both sides, a decrease in the ratio of NAA/Cr concentrations (p<0.05).DUSCUSSION: In the examined children with some neurological and mental disorders accompanied by a delay in mental and speech development, we revealed a significant change in the ratio of NAA/Cr concentrations in areas of the brain associated with the limbic system and subcortical nuclei. It is believed that when the functional integrity of neurons is impaired, the concentration of N-acetylaspartate may change, which is reflected in a change in the ratio of NAA/Cr concentrations. These changes may be responsible for verbal and non-verbal disruptions in social communication and interactions. Also, in these areas of the brain, a significant change in the ratio of Cho/Cr concentrations was recorded, due to an increase in the concentration of choline. This may be due to disorders of higher mental functions, in particular in the construction of complex cognitive circuits responsible for regulating social behavior and interaction with the outside world.CONCLUSIONS: the proton magnetic resonance spectroscopy is a promising additional diagnostic method that allows obtaining (in vivo) information about the state of neurometabolism in brain tissues in children with certain neurological and mental disorders accompanied by a delay in mental and speech development, which can be useful in neurological practice.