{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T12:25:46Z","timestamp":1792758346113,"version":"4.5.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:p>\n                    This study aimed to investigate the diagnostic value of combined glutamate chemical exchange saturation transfer (GluCEST) imaging and \u03b3-aminobutyric acid (GABA)-edited proton magnetic resonance spectroscopy (\n                    <jats:sup>1<\/jats:sup>\n                    H-MRS) in localizing epileptogenic foci and differentiating drug-resistant epilepsy (DR) from drug-responsive epilepsy (DRES) in temporal lobe epilepsy (TLE) using 5T MRI.\n                  <\/jats:p>\n                  <jats:p>Twenty-four TLE patients (13 left, 11 right) and 25 age-\/gender-matched healthy controls (HCs) underwent GluCEST and MEGA-PRESS MRS at 5T MRI. Directional asymmetry indices (DAIglu_H for hippocampus, DAIglu_A for amygdala) and a novel composite biomarker (DAIglu_GABA) integrating GluCEST asymmetry and GABA\/Cr ratios were analyzed. Another asymmetry metric was employed to discriminate the left and right TLE groups [DAIglu_H(epi) for hippocampus, DAIglu_A(epi) for amygdala]. Subgroup comparisons (HC vs. DR vs. DRES) and receiver-operating characteristic (ROC) analyses were performed.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      GluCEST-derived hippocampal asymmetry [DAIglu_H(epi)] effectively lateralized epileptogenic foci (AUC = 0.86). The DRES patients exhibited elevated DAIglu_H (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and reduced GABA\/Cr (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      = 0.015) compared to HCs. The DAIglu_GABA index increased in the DRES subgroup compared to HCs (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). Moreover, DAIglu_GABA levels were found to be significantly lower in the DR subgroup in comparison to the DRES subgroup (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multimodal 5T MRI integrating GluCEST and GABA-MRS provides a clinically feasible tool for lateralizing epileptogenic foci and stratifying drug resistance in TLE. The observed excitatory-inhibitory imbalance dynamics suggest distinct neurometabolic profiles underlying DR and DRES, advancing personalized therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2025.1660608","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T06:31:18Z","timestamp":1763015478000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Excitatory-inhibitory imbalance in temporal lobe epilepsy: a 5T multimodal MRI biomarker for focus localization and drug resistance stratification"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhaodi","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingjun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaona","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangshui","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1152\/jn.00523.2018","article-title":"GABA bouton subpopulations in the human dentate gyrus are differentially altered in mesial temporal lobe epilepsy.","volume":"123","author":"Alhourani","year":"2020","journal-title":"J. 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