Abstract
BackgroundSome recent studies suggest that some imaging-negative temporal lobe epilepsy (TLE) had significant amygdala enlargement (AE). Contradictory data were also reported in previous studies regarding the association between AE and TLE. The present study was to investigate the clinical characters of a group of TLE with AE and compare the amygdala volume of the same patient before and after antiepileptic drugs treatment by a larger sample size.MethodsThis study recruited 33 mesial TLE patients with AE and 35 healthy volunteers. The clinical history, seizure semiology, electroencephalogram (EEG), fluorodeoxyglucose-positron emission tomography (FDG-PET) and amygdala volume were investigated. The amygdala volume were compared between ipsilateral and contralateral sides, TLE patients and 35 healthy controls, and patients at first and follow-up visit by 3.0 T MRI.ResultsAverage seizure onset age was 42.0 years (SD 14.3). All patients had complex partial seizures, fourteen had occasional generalized tonic-clonic seizures which often happened during sleep. Ninety percent patients suffered from anxiety or depression. Thirty percent patients had memory decline. Interictal epileptiform discharges appeared predominantly in the anterior or inferior temporal area ipsilateral to AE. Interictal FDG-PET showed regional glucose hypometabolism in the ipsilateral temporal lobe. No hippocampal sclerosis (HS) was suspected in all patients. 22 patients demonstrated good seizure control and significantly reduced volume of the enlarged amygdala after treatment (P < 0.01). The other 11 patients showed initial response to treatment, followed by a gradual increase in seizure frequency over time, and no volume change of the enlarged amygdala after treatment.ConclusionsTLE with AE probably represents a distinct nosological and probably less homogeneous syndrome which is most likely a subtype of TLE without ipsilateral HS. The chronic and long lasting inflammatory processes or focal cortical dysplasia could lead to amygdala enlargement possibly.
Highlights
Some recent studies suggest that some imaging-negative temporal lobe epilepsy (TLE) had significant amygdala enlargement (AE)
Considering that the above findings are inconsistent and the prior studies are confined to small number of TLE patients, this study aims to investigate the clinical significance of AE in “Magnetic resonance imaging (MRI) negative” TLE patients detected by MRI and compare the amygdala volume of the same patient before and after treatment by a larger sample size
mesial TLE (MTLE) with AE was diagnosed according to semiology and scalp electroencephalogram (EEG) recording, and by 3.0 T MRI, as described below. 3.0 T MRI confirmed AE in all patients, who had lateralized seizures thought clinically and electrically consistent with an origin in the temporal lobe ipsilateral to AE, as determined by the assessment and agreement of two epilepsy specialists
Summary
Some recent studies suggest that some imaging-negative temporal lobe epilepsy (TLE) had significant amygdala enlargement (AE). The amygdala are located in the medial temporal lobe of human brain. They receive extensive nerve input from many different brain areas, such as many sensory areas, hippocampus, hypothalamus, thalamus, frontal lobe and so on [1]. They can influence neuroendocrine, emotional, and cognitive aspects of biologic information processing. Previous studies demonstrated significant amygdala enlargement (AE) was associated with dysphoric disorder and psychosis in TLE patients without hippocampal sclerosis (HS) [7,8].
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