Temporal Lobe Epilepsy with Unilateral Amygdala Enlargement: Morphometric MR Analysis with Clinical and Pathological Study

Kimura, Yukio; Sato, Noriko; Saito, Yuko; Ito, Kimiteru; Kamiya, Kazutaka; Nakata, Yasuhiro; Watanabe, Masaya; Maikusa, Norihide; Sugimoto, Hideharu

doi:10.1111/jon.12106

Cited by 25 publications

(51 citation statements)

References 25 publications

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“…Some reports discussed amygdala volumetry, confirming the existence of AE 7–11 25. To the best of our knowledge, there have been few reports regarding surgical and pathological findings in MTLE with AE, probably because patients with MTLE with AE tend to be less symptomatic and surgery is less likely to be indicated 12 25. Hence, the present study was performed to clarify the intraoperative EEG findings of the amygdala, the pathological findings and the surgical outcome of MTLE with AE.…”

Section: Discussionmentioning

confidence: 87%

“…In a previous report, 8 of 12 surgical cases of AE were pathologically diagnosed as focal cortical dysplasia (FCD) 12. Two pathological cases of AE were also reported previously; the temporal cortex was examined in these cases and disorganisation of the cortical layer and dysmorphic neurons was observed, suggesting the existence of FCD 25. Cytoskeletal impairments, such as hypertrophic neurons, are sometimes observed in cortical dysplasia 29.…”

Section: Discussionmentioning

confidence: 89%

“…However, there are increasing numbers of reports regarding AE, particularly those based on imaging findings. Some reports discussed amygdala volumetry, confirming the existence of AE 7–11 25. To the best of our knowledge, there have been few reports regarding surgical and pathological findings in MTLE with AE, probably because patients with MTLE with AE tend to be less symptomatic and surgery is less likely to be indicated 12 25.…”

Section: Discussionmentioning

confidence: 97%

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Surgery for amygdala enlargement with mesial temporal lobe epilepsy: pathological findings and seizure outcome

Minami

Morino

Uda

et al. 2014

J Neurol Neurosurg Psychiatry

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 97%

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Surgery for amygdala enlargement with mesial temporal lobe epilepsy: pathological findings and seizure outcome

Minami

Morino

Uda

et al. 2014

J Neurol Neurosurg Psychiatry

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“…However, AE is observed at high rates in the amygdala contralateral to seizure onset (Coan et al, 2013) and epileptogenic activity appears to arise from the hippocampus, not the enlarged amygdala (Minami et al, 2015). Prior AE studies included only TLE patients that had concordant EEG findings (Kim et al, 2012; Kimura et al, 2015; Sone et al, 2015; Takaya et al, 2014) or did not specify whether they applied this selection criterion (Coan et al, 2013; Lv et al, 2014; Mitsueda-Ono et al, 2011). To address this unresolved issue, we compare rates of AE, defined quantitatively, across a large sample of individuals with normal MRI and either localization related epilepsy (LRE), IGE, or no epilepsy [i.e., healthy controls (HC)].…”

Section: 1 Introductionmentioning

confidence: 99%

Amygdala enlargement: Temporal lobe epilepsy subtype or nonspecific finding?

et al. 2017

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Objective Amygdala enlargement (AE) is observed in patients with temporal lobe epilepsy (TLE), which has led to the suggestion that it represents a distinct TLE subtype; however, it is unclear whether AE is found at similar rates in other epilepsy syndromes or in healthy controls, which would limit its value as a marker for focal epileptogenicity. Methods We compared rates of AE, defined quantitatively from high-resolution T1-weighted MRI, in a large multi-site sample of 136 patients with nonlesional localization related epilepsy (LRE), including TLE and extratemporal (exTLE) focal epilepsy, 34 patients with idiopathic generalized epilepsy (IGE), and 233 healthy controls (HCs). Results AE was found in all groups including HCs; however, the rate of AE was higher in LRE (18.4%) than in IGE (5.9%) and HCs (6.4%). Patients with unilateral LRE were further evaluated to compare rates of concordant ipsilateral AE in TLE and exTLE, with the hypothesis that rates of ipsilateral AE would be higher in TLE. Although ipsilateral AE was higher in TLE (19.4%) than exTLE (10.5%), this difference was not significant. Furthermore, among the 25 patients with unilateral LRE and AE, 13 (52%) had either bilateral AE or AE contralateral to seizure onset. Conclusion Results suggest that AE, as defined with MRI volumetry, may represent an associated feature of nonlesional localization related epilepsy with limited seizure onset localization value.

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“…Indeed, the stimulation of the left hippocampus, amygdala, and insula induce asystole in humans (7). Recently, unilateral amygdala enlargements have been found in patients with temporal lobe epilepsy (8), and its pathophysiological roles are currently being investigated.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Asystole Triggered by Temporal Lobe Epilepsy with Amygdala Enlargement

et al. 2016

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A 25-year-old previously healthy man was hospitalized for syncope. While standing, he suddenly lost consciousness, followed by a generalized tonic clonic seizure. An electrocardiogram demonstrated asystole. No cardiac abnormalities were detected on the echocardiogram, cardiac magnetic resonance imaging (MRI), positron emission tomography, or a coronary angiogram. An electrophysiological study showed normal sinus node and atrioventricular node function. An electroencephalogram revealed small spike waves in the frontotemporal region. Brain MRI demonstrated a left-sided amygdala enlargement. To the best of our knowledge, this is the first case of temporal lobe epilepsy with an amygdala enlargement that induced cardiac asystole. Case ReportA 25-year-old previously healthy man was hospitalized due to a recent history of syncope with a generalized tonic clonic seizure (GTC). He had experienced prodromes consisting of chest discomfort and flashbacks of visual memory. He was currently receiving carbamazepine (CBZ, 400 mg/ day), as prescribed by another medical facility. No abnormal physical findings were noted except for skin rashes on his trunk. His initial electrocardiogram (ECG) and electroencephalogram (EEG) were normal; magnetic resonance imaging (MRI) of the brain also showed no abnormalities. A laboratory examination revealed moderate liver injury along with mild eosinophilia. At this time, CBZ was discontinued due to potential allergic reactions. After 21 days of admission, while standing beside his bed and talking to his physician, he felt prodromes and suddenly lost consciousness, followed by a GTC that lasted for approximately 30 s. He recovered spontaneously without resuscitation. ECG monitoring at this time demonstrated asystole (5 s and 9 s, respectively, Fig. 1A). On the next day, asystole occurred twice along with prodromes (Fig. 1B). However, he did not lose consciousness and no GTC was observed. He was then transferred to the cardiology department for an evaluation of bradyarrhythmia. Results from Holter ECG monitoring, a signal-averaged ECG, and the head-up tilting test were normal. No cardiac abnormalities were detected on the echocardiogram, cardiac MRI with gadolinium contrast agent, fluorodeoxyglucose positron emission tomography/computed tomography, or coronary angiogram. An electrophysiological study showed normal sinus node function and atrial ventricular node function. A repeat EEG showed small spike waves in the fronto-temporal region (Fig. 2). Antiepileptic medication with zonisamide (ZNS, 400 mg/day) was initiated, and the symptoms disappeared. A permanent cardiac pacemaker was not implanted due to the patient's refusal. Subsequently, he was transferred to the neurosurgery department at the Juntendo University Hospital. Repeat MRI of the brain demonstrated a left-sided amygdala enlargement

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Temporal Lobe Epilepsy with Unilateral Amygdala Enlargement: Morphometric MR Analysis with Clinical and Pathological Study

Abstract: Cortical dysplasia may be one of the pathological diagnoses in AE, and in some patients it may extend to the temporal pole.

Cited by 25 publications

References 25 publications

Surgery for amygdala enlargement with mesial temporal lobe epilepsy: pathological findings and seizure outcome

Surgery for amygdala enlargement with mesial temporal lobe epilepsy: pathological findings and seizure outcome

Amygdala enlargement: Temporal lobe epilepsy subtype or nonspecific finding?

Cardiac Asystole Triggered by Temporal Lobe Epilepsy with Amygdala Enlargement

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