Objective: To measure the volume of basal forebrain septal nuclei in patients with temporal lobe epilepsy (TLE) as compared to patients with extratemporal epilepsy and controls. In animal models of TLE, septal lesions facilitate epileptogenesis, while septal stimulation is antiepileptic.Method: Subjects were recruited from 2 sites and consisted of patients with pharmacoresistant focal epilepsy (20 with TLE and mesial temporal sclerosis [MTS], 24 with TLE without MTS, 23 with extratemporal epilepsy) and 114 controls. Septal volume was measured using high-resolution MRI in association with newly developed probabilistic septal nuclei maps. Septal volume was compared between subject groups while controlling for relevant factors.Results: Patients with TLE without MTS had significantly larger septal nuclei than patients with extratemporal epilepsy and controls. This was not true for patients with MTS. These results are interpreted with reference to prior studies demonstrating expansion of the septo-hippocampal cholinergic system in animal models of TLE and human TLE surgical specimens. Human septal nuclei, located in the basal forebrain, consist of the medial septum and diagonal band of Broca. Septal nuclei provide the main cholinergic input to the hippocampus via the fimbria/fornix 1 and are critical for hippocampal theta oscillations that mediate learning and memory. 2,3 In animal models of temporal lobe epilepsy (TLE), medial septal lesions facilitate epileptogenesis, and chemical or electrical septal stimulation can stop and prevent seizures.
Conclusion:4-8 To our knowledge, no studies have examined septal nuclei structure in human TLE.We used MRI in association with probabilistic maps of human septal nuclei 9 to measure septal volume in patients with TLE either with or without mesial temporal sclerosis (MTS), patients with partial epilepsy not involving the hippocampus (extratemporal epilepsy [ETE]), and healthy controls. Based on prior human MRI studies showing atrophy of hippocampi and connected limbic regions in TLE including the fornix, 10,11 we initially hypothesized that septal volume would be reduced in TLE. Contrary to this hypothesis, we found septal enlargement in TLE without MTS.METHODS Subjects. All subjects provided informed consent to participate in this institutional review board-approved study. Patients with epilepsy were recruited from either the New York University (NYU) or University of California, San Diego (UCSD) Epilepsy Center. See table 1 for subject information. All patients had medically intractable seizures and were being considered for epilepsy surgery. Seizure focus lateralization/localization was made by experienced epileptologists based on clinical criteria including neuroimaging, video-EEG, and intracranial EEG (icEEG) when available. Patients with TLE were categorized as having MTS (TLE-MTS) or not based on standard criteria.12 PatientsFrom the Comprehensive Epilepsy Center (T.B., X