Abstract
Objective: The objective of this study was to determine the relationship between atrophy of the hippocampus and severity of epilepsy in patients with temporal lobe epilepsy (TLE) as the first step to evaluate the possibility of surgery for epilepsy and analyze why patients cannot undergo epilepsy surgery.Methods: Volumetric MRI of the hippocampus was performed in 51 consecutive patients (29 men; mean age 40) with TLE. TLE diagnosis, lateralization, and severity (mild, moderate, severe) of seizures were based on a comprehensive evaluation that included neurologic examination and EEG in all patients. Patients with evidence of a lesion other than hippocampal sclerosis were not included in the study. We assessed the relationship between hippocampal volumes and electrophysiological evidence of seizure severity.Results: According to the affected side based on the EEG, a statistically significant difference (p < 0.001) in volume and a positive correlation between epilepsy and hippocampal atrophy were found.Conclusion: Our results confirm that volume loss to the hippocampus in patients with TLE correlates with the severity of epilepsy based on the EEG. Therefore, surgical treatment is considered early when hippocampal atrophy is evident in patients with refractory TLE. However, in Latin American countries, it is a challenge to get a patient to undergo epilepsy surgery. Therefore, we try to analyze the sad situation in our hospital.
Highlights
Epilepsy [according to the International League Against Epilepsy, ILAE, and the International Bureau for Epilepsy, IBE, (2005)] is defined as a brain disorder characterized by predisposition to generate recurrent epileptic seizures, which usually leaves neurobiological, cognitive, psychological, and social consequences, in which the presence of at least one epileptic seizure is necessary [1]
In 1989, temporal lobe epilepsy (TLE) was included in the ILAE classification under the group of symptomatic localization-related epilepsies
We found that the mathematical measures that correlated most strongly with EEG were volume and voxels, showing statistical significance in all six classified groups
Summary
Epilepsy [according to the International League Against Epilepsy, ILAE, and the International Bureau for Epilepsy, IBE, (2005)] is defined as a brain disorder characterized by predisposition to generate recurrent epileptic seizures, which usually leaves neurobiological, cognitive, psychological, and social consequences, in which the presence of at least one epileptic seizure is necessary [1]. Analysis of Clinical, EEG, and MRI for Localization in Temporal Lobe Epilepsy. An epileptic seizure is a recurrent event characterized by the transient presence of signs and symptoms due to abnormal overactivity or synchronous neuronal activity in the brain [1]. Factors that influence the form of manifestation of an epileptic seizure are: (a) the location of the abnormal neuronal overactivity in the brain, (b) the mode of propagation, (c) brain maturity, (d) the patient’s underlying disease, (e) the sleep-wake cycle, (f) medications, and (g) the clinical semiology of seizures, among others. The EEG and MRI [3] can help localize the abnormality in function or structure of the brain, especially in temporal lobe epilepsy (TLE). In the new classification of seizures, most TLE seizures are recognized as focal, with impaired awareness, motor onset and automatism, non-motor onset and behavioral arrest, or cognitive alteration sometimes with bilateral tonic-clonic propagation [5]
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