The objective of this prospective study was the application of proton magnetic 
resonance spectroscopy in children with spastic diplegia (SD) to determine the 
metabolite profile of SD children in the left basal ganglia, and to assess the 
relationship of this profile with motor and mental development. Patients with SD 
showed reduced ratios of N-acetylaspartate (NAA)/creatine (Cr), NAA/choline 
(Cho), NAA/myo-inositol (mI), Cho/NAA, Cho/Cr and Cho/mI in the basal ganglia 
compared to a well-matched control group. On the other hand, we noted increased 
Cr/NAA, Cr/Cho and mI/NAA ratios in the SD patients as compared with controls. 
NAA/mI ratios were positively correlated with the severity scale of cerebral 
palsy in SD children. There was also a significant correlation between Cr/NAA 
and mental retardation. Increased Cr/NAA, Cr/Cho and mI/NAA ratios in SD 
children may suggest the existence of the compensatory mechanisms in these 
patients. The NAA/mI ratio could be used as an additional marker of SD severity 
and Cr/NAA as a marker of the mental retardation.