Clinical Patterns of Patients with Temporal Lobe Epilepsy and Pure Amygdalar Atrophy

Abstract

Summary:Purpose: MRI volumetric measurements (MRIvo,) have been proven reliable in determining mesial temporal atrophy in patients with TLE. We attempted to correlate the clinical features with different patterns of hippocampal formation (HF) and amygdala (AM) atrophy in patients with TLE without foreign tissue lesion.Methods: We studied 65 patients with refractory TLE. They were divided into five groups according to MRI,,, results: pure AM atrophy (n = 1 1, 10 unilateral and one bilateral), unilateral HF atrophy (n = 16), bilateral HF atrophy (n = 12), unilateral AM+HF atrophy (n = 13), and patients with normal volumes of AM and HF (n = 13). MRI,,, of AM and HF were performed by using a protocol previously described by Watson et al. (Neurology I992;42: 1743-50).Results: Patients with AM atrophy had later onset of seizures compared with those with unilateral HF atrophy (p < 0.01). History of febrile convulsions (p c 0.0001) and frequent secondarily generalized tonic-clonic seizures (GTCSs) were more often found in patients with HF atrophy compared with those with pure AM atrophy and those with normal volumes (p = 0.04). Prolonged postictal confusion was more often found with AM atrophy (p = 0.05). Memory impairment was more severe in patients with HF atrophy than in those with AM atrophy only or in those with normal volumes (p = 0.03). There were no significant differences among the five groups in the following parameters: age, duration of epilepsy, seizure frequency, and presence and type of aura. Conclusions: Prolonged postictal confusion appeared to be related to AM atrophy, in keeping with previous clinical observations. These patients also had a lower incidence of early febrile convulsions, older age at epilepsy onset, lower frequency of secondary GTCS, and lesser memory dysfunction compared with patients with hippocampal atrophy. Key Words: Amygdala-Hippocampus-Temporal lobe epilepsy-Magnetic resonance imaging-Memory .The amygdala (AM) and hippocampal formation (HF) have an important role in the pathogenesis of temporal lobe epilepsy (TLE; 1-3). Magnetic resonance imaging (MRI) volumetric measurements (MRIvoJ are efficient and reliable in lateralizing and localizing underlying structural abnormalities in many patients with TLE (4-7). Hippocampal atrophy has been found in 50-70% of surgically treated patients with TLE (8-1 0). The pathologic findings indicate neuronal loss and gliosis in sectors of the HF, but these also extend to other structures including the AM, entorhinal cortex, and parahippocamcytoarchitectonic and chemoarchitectonic patterns such as frequently found in the HF; also the surgical specimen is often not removed en bloc, making pathologic study difficult (1).We do not know whether there are distinct clinical features characteristic or indicative of different patterns of AM or HF atrophy. We used MRI,,, to correlate different types of atrophy of mesial temporal structures with clinical patterns of patients with TLE.

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“…It has long been acknowledged that people with epilepsy of temporal origin characteristically experience memory failures to varying degrees [128][129][130][131][132] . With epilepsy surgery, there was an explosion of surgical excisions of the hippocampus along with the amygdala and hippocampal gyrus 64 , and a deluge of literature outlining the neuropsychological consequences of unilateral temporal lobectomies.…”

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“…Tests for assessing frontal lobe functions include the Wisconsin Card Sorting, Design Fluency, Stroop, tower, trail-making, finger-tapping, and Purdue or Grooved Pegboard tests [19,43,69,102,118,135,158,175,224,228,235]. The Rey-Osterrieth Complex Figure Test and somatosensory tests such as two-point discrimination are used to assess parietal lobe function [71,98,118,153,177]. Memory tests focus on learning and retention of both verbal and nonverbal material.…”

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“…Reduction of the volume of the amygdala has been shown to be able to lateralize patients with temporal lobe epilepsy (8,9), and has also been shown to occur in recurrent depression (10), obses-L. Bonilha et al sive-compulsive disorder (11), Alzheimer disease (12), and in male subjects with schizophrenia (13). Conversely, patients with autism (14), bipolar-affective disorder and female patients with schizophrenia show an increased amygdala volume (13).…”