Abstract
Background:Amygdalae play a central role in emotional processing by interconnecting frontal cortex and other brain structures. Unilateral amygdala enlargement (AE) is associated with mesial temporal lobe epilepsy (mTLE). In a relatively large sample of patients with mTLE and AE, we aimed to evaluate functional integration of AE in emotion processing and to determine possible associations between fMRI activation patterns in amygdala and deficits in emotion recognition as assessed by neuropsychological testing.Methods:Twenty-two patients with drug resistant unilateral mTLE due to ipsilateral AE were prospectively recruited in a large epilepsy unit and compared with 17 healthy control subjects in terms of amygdala volume, fMRI activation patterns and performance in emotion recognition as assessed by comprehensive affect testing system (CATS) and Ekman faces. All patients underwent structural and functional 1.5 Tesla MRI, electro-clinical assessment and neuropsychological testing.Results:We observed BOLD signal ipsilateral to AE (n = 7; group PAT1); contralateral to AE (n = 6; group PAT2) and no activation (n = 9; group PAT3). In the region of interest (ROI) analysis, beta estimates for fearful face > landscape contrast in the left amygdala region did not differ significantly in patients with left TLE vs. patients with right TLE [T(16) = −1.481; p = 0.158]. However, beta estimates for fearful face > landscape contrast in the right amygdala region were significantly reduced in patients with right TLE vs. patients with left TLE [T(16) = −2,922; p = 0.010]. Patients showed significantly lower total scores in CATS and Ekman faces compared to healthy controls.Conclusion:In our cohort, patients with unilateral mesial TLE and ipsilateral AE, an amygdala could display either functional integration in emotion recognition or dysfunction as demonstrated by fMRI. Perception and recognition of emotions were impaired more in right-sided mTLE as compared to left-sided mTLE. Neuropsychological tests showed deficits in emotion recognition in patients as compared to healthy controls.
Highlights
The amygdala, a temporal lobe structure is of central importance for emotional behavior, and plays a key role in epileptogenesis and epilepsy [1].Amygdala enlargement (AE) on MRI without hippocampal structural abnormalities has been associated with a subtype of mesial temporal lobe epilepsy (TLE) [2, 3]
We have demonstrated in a small group of patients with possible amygdala dysplasia and mesial TLE that the function might be retained by enlarged amygdala raising concerns about post-surgical deficits [25]
We present a larger sample of patients with unilateral mesial TLE due to ipsilateral amygdala lesion with functional imaging, behavioral and electro-clinical data aiming to evaluate the functional integration of enlarged amygdala in emotion processing and to determine possible associations between fMRI activation patterns in amygdala and deficits in emotion recognition as assessed by neuropsychological testing
Summary
The amygdala, a temporal lobe structure is of central importance for emotional behavior, and plays a key role in epileptogenesis and epilepsy [1]. Amygdala enlargement (AE) on MRI without hippocampal structural abnormalities has been associated with a subtype of mesial temporal lobe epilepsy (TLE) [2, 3]. The changes observed on MRI usually vanish in the course of weeks or months correlating with the seizure frequency reduction, returning to either “normal” size or resulting in amygdala atrophy (along with other mesial temporal structures). Amygdalae play a central role in emotional processing by interconnecting frontal cortex and other brain structures. Unilateral amygdala enlargement (AE) is associated with mesial temporal lobe epilepsy (mTLE). In a relatively large sample of patients with mTLE and AE, we aimed to evaluate functional integration of AE in emotion processing and to determine possible associations between fMRI activation patterns in amygdala and deficits in emotion recognition as assessed by neuropsychological testing
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