海马硬化致颞叶癫癎的SPECT与MRI研究

目的探讨SPECT脑血流灌注显像结合MRI测量海马体积对海马硬化致颞叶癫癎患者致灶的定位价值。方法采用99Tcm-双半胱乙酯(99Tcm-ECD)SPECT脑血流灌注显像对双侧海马血流灌注进行定性和半定量分析,MRI测量双侧海马体积,分析海马硬化致颞叶癫癎(颞叶癫癎组)患者患侧海马相对脑血流量与相应区域海马体积的相关性。结果颞叶癫癎组患者患侧海马相对脑血流量[(46.04±7.94)ml/(100 g·min)]低于对侧[(54.76±9.62)ml/(100 g·min);t=-2.966,P=0.005]和正常对照者[(64.87±7.28)ml/(100 g·min);t=-4.824,P=0.000],且海马体积[(1.69±0.39)cm3]小于对侧[(2.68±0.41)cm3;t=-7.410,P=0.000]和正常对照者[(3.50±0.39)cm3;t=-16.340,P=0.000]。海马硬化致颞叶癫癎患者患侧海马相对脑血流量与相应区域海马体积呈正相关(r=0.394,P=0.017)。结论海马硬化致颞叶癫癎患者患侧海马相对脑血流量降低、海马体积缩小,二者呈正相关。SPECT脑血流灌注显像结合MRI测量海马体积,可以作为致灶切除术前准确定位的参考依据。     

匹罗卡品致(癎)大鼠海马γ-氨基丁酸能中间神经元生长抑素和微清蛋白mRNA表达研究

目的 观察匹罗卡品致(癎)大鼠海马γ-氨基丁酸能中间神经元生长抑素(SS)mRNA和微清蛋白(PV)mRNA表达水平变化,拟从基因水平探讨其表达阳性γ-氮基丁酸能中间神经元在颞叶癫(癎)发生发展中的作用.方法 建立匹罗卡品致(癎)大鼠模型,采用原位杂交法检测各观察时间点海马SSmRNA和PVmRNA表达阳性神经元数目.结果 模型组大鼠海马各区γ-氨基丁酸能中间神经元SSmRNA表达水平均于出现癫(癎)持续状态后3d降低最为显著(均P=0.000),随后逐渐升高;至发病后60d,海马CA3区SSmRNA表达水平高于对照组(t=1.021,P=0.005),海马门区(t=3.211,P=0.009)和CA1区(t=1.902,P=0.048)则仍低于对照组.模型组大鼠海马门区γ-氨基丁酸能中间神经元PVmRNA表达水平于出现癫(癎)持续状态后6h开始降低,至发病后60d降低最为显著(均P=0.000);海马CA1区PVmRNA表达水平于发病后3d降低最为显著(均P=0.000),随后逐渐升高但仍低于对照组(江2.216,P=0.048);癫(癎)持续状态早期,海马CA3区PVmRNA表达水平无明显变化,至发病后7d逐渐升高且高于对照组(t=1.021,P=0.005).结论 γ-氨基丁酸能中间神经元SSmRNA和PVmRNA表达水平的下调可能在颞叶癫(癎)的发生中起重要作用,至慢性期γ-氨基丁酸能中间神经元SSmRNA和PVmRNA表达水平的恢复或上调可能与颞叶癫(癎)的发展或修复有关.γ-氨基丁酸能中间神经元数目的 变化,部分是由于其标志物mRNA表达水平的调节所致,并非神经元数目变化的唯一因素.     

Akt1在颞叶癫痫大鼠海马中的表达变化

目的研究颞叶癫癎模型海马区神经元Akt1表达变化,探讨其在癫癎发生发展中的作用。方法采用氯化锂-匹罗卡品方法制备颞叶癫癎大鼠模型,Western blotting检测海马区总蛋白、Quantity one软件行灰度值分析;免疫组织化学染色观察海马各区Akt1蛋白表达变化,计数不同处理组阳性神经元数目。结果 Western blotting检测结果显示,与正常对照组相比,癫癎模型组大鼠于癫癎持续状态发作即刻海马区Akt1蛋白表达升高(t=2.445,P=0.034),并于第30天时达峰值水平(t=1.214,P=0.002),发作后24 h表达水平迅速降低,并低于正常值范围(t=4.294,P=0.000),其余各测量时间点表达无明显改变;与氯化锂组相比,癫癎模型组大鼠于癫癎持续状态后1h海马区Akt1蛋白表达开始降低,24 h降至最低水平(t=4.134,P=0.000),至发作48 h后开始逐渐升高(t=2.481,P=0.002),并于发作第7天时升至氯化锂组水平。免疫组织化学染色显示,癫癎持续状态发作后海马CA3区Akt1蛋白表达阳性神经元数目立即增加,12h达高峰(t=16.586,P=0.000),48 h减少并降至正常值水平(t=0.357,P=0.089),发作后第10天再次增加(t=3.123,P=0.000),于第30天时阳性神经元数目再次达峰值水平(t=18.339,P=0.000),第50天开始恢复至正常值水平(t=3.219,P=0.000);氯化锂组仅海马CA3区Akt1蛋白表达于实验初始(0 h)升高并高于正常对照组(P<0.05),海马CA1和CA2区Akt1蛋白表达变化组间差异均无统计学意义(P>0.05)。结论海马及海马CA3区Akt1蛋白表达均呈现癫癎持续状态后升高、降低、再升高的动态过程,提示可能存在神经元保护作用,对抗细胞凋亡、促进细胞存活。     

双侧颞叶癫(癎)的立体定向外科治疗

目的 探讨双侧海马-杏仁核复合体毁损术治疗双侧颞叶癫(癎)的疗效.方法 回顾性分析5例双侧颞叶癫(癎)病人的临床资料,复杂部分性发作中的自动症1例,部分性继发全身性癫(癎)4例.均行深部电极引导下机器人辅助定位双侧海马-杏仁核复合体毁损术.结果 随访1～2.5年,按Engel分级:Ⅰ级2例;Ⅱ、Ⅲ、Ⅳ级各1例.术后MRI显示:双侧海马-杏仁核复合体区无严重的结构性破坏.智商、心算速度、符号数字配对、划消、数字记忆广度、指扣试验等神经心理学检查指标手术前后差异均无统计学意义(P＞0.05).结论 双侧颞叶癫(癎)无法实施切除性手术,而立体定向外科治疗可减少癫(癎)发作,且并未造成严重认知功能障碍,是一种值得尝试的外科治疗手段.     

皮质下缺血性血管性认知损害扩散张量成像研究

目的通过扩散张量成像(DTI)探讨皮质下缺血性血管性认知损害患者白质微结构变化及其与认知功能之间的相关性。方法采集49例皮质下缺血性脑血管病患者[轻度血管性痴呆(VaD)10例、非痴呆型血管性认知损害(VCIND)20例、认知功能正常19例]DTI数据并观察皮质下白质微结构改变,分析VaD组患者DTI参数与认知功能间的相关性。结果与对照组相比,VaD组内侧前额叶、前扣带回、胼胝体干、双侧顶叶、右侧颞叶、双侧眶额叶,以及VCIND组右侧额下回、右侧海马、双侧楔前叶FA值减低(均P=0.000);与VCIND组比较,VaD组内侧前额叶、前扣带回、胼胝体、双侧顶叶、右侧颞叶FA值减低(P=0.000)。与对照组相比,VaD组内侧前额叶、胼胝体、双侧顶叶、双侧颞叶、前扣带回,以及VCIND组双侧楔前叶、右侧海马MD值升高(均P=0.000);与VCIND组相比,VaD组右侧内侧前额叶、前扣带回、胼胝体干、双侧顶叶、双侧颞叶MD值升高(均P=0.000)。VaD组内侧前额叶FA值与数字连线测验A时呈显著负相关(r=-0.782,P=0.007),双侧额下回MD值与数字连线试验A时程呈显著正相关(r=0.877,P=0.001)。结论 DTI对皮质下缺血性认知损害患者白质微结构改变更敏感,能够反映患者认知功能早期异常改变;内侧前额叶白质微结构的改变是影响患者执行能力的重要因素。     

MRI对颞叶癫(癎)的定侧诊断的价值

目的 观察颞叶癫(癎)患者的头颅MRI变化,探讨MRI对颞叶癫(癎)的定侧诊断价值.方法 采用头颅MRI检查,对40例颞叶癫(癎)患者及40例正常对照组的海马体积进行测量,将海马萎缩严重侧作为致癎侧.结果 定量MRI对颞叶癫(癎)定侧敏感性为72.5%,特异性为85.3%.结论 头颅MRI扫描对颞叶癫(癎)的定位及定侧有着重要的诊断价值.     

普瑞巴林对慢性颞叶癫癎大鼠海马凋亡调控基因的影响

目的通过观察普瑞巴林对匹罗卡品慢性癫癎大鼠海马区Bcl-2和Bax表达的影响,探讨普瑞巴林治疗癫癎的药理学机制及对大鼠海马神经元的抗凋亡作用。方法采用氯化锂-匹罗卡品化学诱导方法建立慢性颞叶癫癎模型。经腹腔注射普瑞巴林40mg(/kg·d)连续治疗3周,免疫组织化学染色和Western blotting法检测不同处理组大鼠海马区Bcl-2和Bax表达变化。结果与生理盐水对照组比较,模型组大鼠海马区Bcl-2和Bax表达水平显著升高(均P=0.000);与模型组比较,普瑞巴林治疗组大鼠海马区Bcl-2表达水平升高、Bax表达水平降低,组间差异具有统计学意义(均P=0.000)。结论新型抗癫癎药物普瑞巴林可通过降低慢性颞叶癫癎大鼠海马区Bax表达、上调Bcl-2表达而抑制细胞凋亡,发挥神经元保护作用。     

癫癎患者的认知功能损害及其独立危险因素分析

目的探讨新诊断的癫癎患者认知功能改变的独立危险因素.方法对我院癫癎专科新诊断为癫癎并符合研究要求的患者60例,治疗前接受韦氏智力量表测定,并记录临床情况,比较其智商及构成因子与对照组的差异;进行认知功能影响因素分析,筛选出影响癫癎患者认知功能的独立危险因素.结果癫癎患者的全量表智商、言语智商和操作智商以及言语理解因子、知觉组织因子均低于健康对照(P＜0.05),成人亚组和儿童亚组亦见相似结果(P＜0.05).病程和发作频率均与患者的全量表智商、言语智商和操作智商呈负相关(P＜0.05);发病年龄、发作类型、家族史以及致癎灶是否在优势半球,均与癫癎患者智商水平无关.进一步以病程作协变量,总量表智商和发作频率的相关度为r=-0.243(P＜0.01);以发作频率作协变量,总量表智商和病程的相关度r=-0.155(P＞0.05).结论癫癎患者人群的智商平均水平低于正常人群的智商平均水平;癫癎发作的频率是癫癎患者总体认知功能低下的独立危险因素.     

难治性颞叶癫痫危险因素的配比病例对照研究

目的 分析颞叶癫癎成为难治性癫癎的危险因素,为临床需要提供客观的指征。方法 将163例药物难治性颞叶癫癎患者与同期的非难治性颞叶癫癎患者进行1:1配比病例对照研究,应用条件Logistic回归分析方法处理数据。结果 多因素条件Logistic回归分析表明颞叶癫癎成为难治性的有统计学显著性意义的重要危险因素是:神经系统疾患(OR=3.635,95％CI:1.805-7.320)、双颞癎性放电(OR=4.289,95％CI:2.192-8.389)、海马硬化(OR=4.558,95％CI:1.890-10.992)、起病年龄早(OR=0.353,95％CI:0.144-0.867)和2年内未及时治疗(OR=0.418,95％CI:0.208-0.837)。结论 具有神经系统疾患、双颞癎性放电、海马硬化、起病年龄早和2年内未及时治疗是难治性颞叶癫癎的重要危险因素。     

脑白质高信号患者认知障碍与海马亚区萎缩的相关性研究

目的 探讨脑白质高信号（white matter hyperintensity,WMH）患者海马亚区的萎缩情况及其与认知 功能障碍的相关性。 方法 前瞻性连续纳入南京鼓楼医院2017年1月-2019年12月收治的WMH患者,将同期门诊招募的健 康志愿者作为正常对照。所有受试者接受头颅MRI检查及认知功能检查,根据MMSE和MoCA评分将 WMH患者分成无认知障碍组及认知障碍组。利用FreeSurfer 6.0软件进行海马亚区的分割,计算双侧 海马尾、下托、CA1、海马裂、前下托、旁下托、分子层、齿状回、CA3、CA4、海马伞及海马杏仁核过渡区 的亚区体积,同时计算脑室周围、深部及总WMH体积。比较对照组、WMH认知障碍组和WMH无认知障 碍组之间总海马体积及各海马亚区体积的差异。在WMH患者中分析萎缩的海马亚区与WMH体积的相 关性,在WMH伴认知障碍组中分析海马亚区体积与各个认知域功能障碍的相关性。 结果 共纳入对照组85例,WMH无认知障碍组79例及WMH认知障碍患者89例。与对照组相比,WMH 无认知障碍组患者右侧齿状回（P =0.006）、CA3（P =0.006）和CA4（P =0.020）海马亚区出现萎缩,而 WMH认知功能障碍组则表现为右侧下托（P =0.022）、分子层（P =0.003）、齿状回（P =0.001）、CA3 （P =0.039）、CA4（P =0.003）及双侧海马伞亚区（左侧P =0.004,右侧P =0.020）体积降低。在WMH患者 中,右侧齿状回体积与总WMH体积（r =-0.134,P =0.035）及室周WMH体积（r =-0.128,P =0.045）呈负 相关,右侧CA3体积同样与总WMH（r =-0.149,P =0.020）及室周WMH（r =-0.139,P =0.029）呈负相关。 此外,在WMH伴认知障碍组中,总体认知功能（r =0.315,P =0.004）及语言功能（r =0.318,P =0.006） 均与右侧下托体积呈正相关;执行功能则与右侧分子层（r =0.300,P =0.006）、齿状回（r =0.333, P =0.002）和CA4（r =0.323,P =0.003）的体积呈正相关。 结论 WMH患者表现为非对称性海马萎缩模式,以右侧海马萎缩为主。右侧分子层、齿状回及CA4区 亚区影响WMH患者执行功能而右侧下托的萎缩则影响总体认知和语言功能。     

Bilateral hippocampal atrophy: consequences to verbal memory following temporal lobectomy

BACKGROUND: Bilateral hippocampal damage is a risk factor for memory decline after anterior temporal lobectomy (ATL). OBJECTIVE: To investigate verbal memory outcome in patients with temporal lobe epilepsy (TLE) with either unilateral or bilateral hippocampal atrophy as measured by MRI. METHODS: The authors selected 60 patients with TLE who had undergone ATL (left = 31, right = 29). They determined normalized MRI hippocampal volumes by cursor tracing 1.5-mm slices from three-dimensional MRI acquisition. Hippocampal volumes were defined as atrophic if the volumes were below 2 SD for control subjects. Bilateral hippocampal atrophy was present in 10 patients with left TLE and 11 patients with right TLE. The authors assessed acquisition, retrieval, and recognition components of verbal memory both before and after ATL. RESULTS: Groups did not differ across age, education, intelligence, age at seizure onset, or seizure duration. Seizure-free rates after ATL were 70% or higher for all groups. Before surgery, patients with left TLE displayed worse verbal acquisition performance compared with patients with right TLE. Patients with left TLE with bilateral hippocampal volume loss displayed the lowest performance across all three memory components. After surgery, both groups of patients with left TLE exhibited worse verbal memory outcome compared with patients with right TLE. Bilateral hippocampal atrophy did not worsen outcome in the patients with right TLE. A higher proportion of patients with left TLE with bilateral hippocampal atrophy experienced memory decline compared with the other TLE groups. CONCLUSION: Bilateral hippocampal atrophy in the presence of left TLE is associated with worse verbal memory before and after ATL compared with patients with unilateral hippocampal volume loss or right TLE with bilateral hippocampal volume loss.     

Volumetric Magnetic Resonance Imaging Evidence of Bilateral Hippocampal Atrophy in Mesial Temporal Lobe Epilepsy

Summary: Purpose : We measured absolute volumes and volume differences of hippocampi in patients with mesial temporal lobe epilepsy (MTLE) using volumetric magnetic resonance imaging (MRI) to determine the extent of bilateral atrophy in MTLE and to relate hippocampal volumes (HV) to outcome of temporal lobectomy.
Methods : HV and hippocampal differences (HD) were measured in 40 patients with MTLE determined by pathology of hippocampal sclerosis (HS) and compared with those of age-matched controls. Results were matched with surgical outcome.
Results : Hippocampi contralateral to lobectomy (right hippocampi 2.96 ± 0.49 cm³, left 3.14 ± 0.51 cm³) were significantly smaller than those of controls (right hippocampi 3.73 ± 0.52 cm³, left 3.60 ± 0.51 cm³ but were significantly larger than hippocampi ipsilateral to lobectomy (right hippocampi 2.63 ± 0.61 cm³, 2.18 cm³) as compared across groups by analysis of variance (ANOVA: F = 27.2, p < 0. 0001). The smaller hippocampus was ipsilatera1 to lobectomy in 39 of 40 cases. Seven of 40 MTLE patients (18%) had bilateral atrophy, defined by volumes of each hippocampi 2 SD lower than control means. Surgical outcome was independent of hippocampal asymmetry and bilateral atrophy measured by chi-square and Fisher's exact tests.
Conclusions : We determined that most patients with MTLE have some degree of bilateral, asymmetric hippocampal pathology. However, asymmetry and bilateral atrophy have no clear relation to surgical outcome.     

Effect of apolipoprotein ε4 allele on hippocampal and brain volume in intractable temporal lobe epilepsy

This study investigated the relationship between the apolipoprotein (APOE) ε4 allele and brain volumes in patients with medically intractable temporal lobe epilepsy (TLE). MRI-based volumetric analyses of the hippocampi, cerebral hemispheres, and whole brain were conducted in 59 patients with TLE (31 with left TLE, 28 with right TLE) with hippocampal sclerosis (HS). There were no differences in hippocampal, hemispheric, or whole brain volumes as a function of ε4 status even after correcting for hemispheric and total brain volumes. However, APOE ε4 carriers showed a trend toward having a smaller discrepancy between ipsilateral and contralateral hippocampal volumes than patients without this allele, and post hoc analyses suggest there may be an increased incidence of bilateral HS in ε4 carriers. In summary, APOE ε4 is not associated with significant hippocampal, hemispheric, or whole brain atrophy in patients with medically intractable TLE. However, ε4 carriers may be more likely to have bilateral HS, with an apparent dose-dependent effect.     

Evaluation of bilateral cingulum with tractography in patients with Alzheimer's disease

A fiber-tracking algorithm was used to extract fractional anisotropy of bilateral cingulum bundles in patients with probable Alzheimer's disease and normal aging controls. In addition, their hippocampal volumes were measured manually. Relative to normal controls, Alzheimer's disease patients showed a significant reduction of fractional anisotropy and hippocampal volumes. Significant correlation was observed between fractional anisotropy values and volumes of hippocampi and mini-mental state examination scores. This study suggests that lower anisotropy of cingulum bundles is associated with cognitive dysfunction and atrophy of the limbic system.     

Distribution of regional gray matter abnormalities in a pediatric population with temporal lobe epilepsy and correlation with neuropsychological performance

OBJECTIVE: The goals of the work described here were to determine if hippocampal and extrahippocampal atrophy in children with temporal lobe epilepsy (TLE) follows a pattern similar to that in adult patients, and to assess the clinical and neuropsychological relevance of regional brain atrophy in pediatric TLE. METHODS: Children with symptomatic TLE (n=14: 9 with mesial TLE due to hippocampal atrophy and 5 with TLE due to neocortical lesions), healthy children (n=14), and 9 adults with mesial temporal lobe epilepsy (MTLE) were compared using voxel-based morphometry (VBM) of brain magnetic resonance imaging (MRI). The children underwent a comprehensive neuropsychological battery. RESULTS: Children with MTLE with unilateral hippocampal atrophy (n=9) exhibited a significant reduction in gray matter in the hippocampus ipsilateral to the seizure origin and significant atrophy in the ipsilateral cingulate gyrus and contralateral middle frontal lobe. Children with TLE (n=14) exhibited a significant reduction in the gray matter of the ipsilateral hippocampus and parahippocampal gyrus. There was a correlation between gray matter volume in children with TLE and scores on several neuropsychological tests. Atrophy in pediatric patients with MTLE was less extensive than that in adults, and involved the hippocampi and the frontal cortex. CONCLUSIONS: Similar to adult MTLE, pediatric MTLE is associated with hippocampal and extrahippocampal cell loss. However, children display less intense quantifiable gray matter atrophy, which affects predominantly frontal lobe areas. There was a significant association between volume of gray matter in medial temporal and frontal regions and scores on neuropsychological tests. In childhood, TLE and the concomitant cognitive/behavior disturbances are the result of a damaged neural network.     

Psychopathological profile in patients with severe bilateral hippocampal atrophy and temporal lobe epilepsy: evidence in support of the Geschwind syndrome?

Bilateral symmetrical hippocampal atrophy (BHA) has been implicated as a possible causal element in various neuropsychiatric disorders, in particular depressive disorder and schizophrenia. To test the hypothesis that bilateral symmetrical severe volume loss of the hippocampi is of causal relevance to these psychiatric syndromes rather than an epiphenomenon we assessed the psychopathology in a group of patients with temporal lobe epilepsy (TLE) and very severe bilateral symmetrical hippocampal atrophy and compared it with that of a patient control group. Patients with TLE and hippocampal volumes smaller than three standard deviations below the mean of a control population were identified and compared with a matched patient population with normal hippocampal volumes. Psychopathology was assessed by blinded trained psychiatrists using the Present State Examination and Neurobehavioral Inventory. The prevalence of psychiatric syndromes was high in both patient groups; however, there was no significant difference between the two groups. With use of the more specific Neurobehavioral Inventory a psychopathological pattern reminiscent of the Geschwind syndrome emerged when patients with BHA were characterized by caregivers. While BHA does not result in an increased prevalence of specific psychiatric syndromes, specific symptoms that characterize the Geschwind syndrome like hypergraphia and hyposexuality might be pathogenically related to hippocampal atrophy.     

Clinical patterns of patients with temporal lobe epilepsy and pure amygdalar atrophy

PURPOSE: MRI volumetric measurements (MRIvol) have been proven reliable in determining mesial temporal atrophy in patients with TLE. We attempted to correlate the clinical features with different patterns of hippocampal formation (HF) and amygdala (AM) atrophy in patients with TLE without foreign tissue lesion. METHODS: We studied 65 patients with refractory TLE. They were divided into five groups according to MRIvol results: pure AM atrophy (n = 11, 10 unilateral and one bilateral), unilateral HF atrophy (n = 16), bilateral HF atrophy (n = 12), unilateral AM + HF atrophy (n = 13), and patients with normal volumes of AM and HF (n = 13). MRIvol of AM and HF were performed by using a protocol previously described by Watson et al. (Neurology 1992;42:1743-50). RESULTS: Patients with AM atrophy had later onset of seizures compared with those with unilateral HF atrophy (p < 0.01). History of febrile convulsions (p < 0.0001) and frequent secondarily generalized tonic-clonic seizures (GTCSs) were more often found in patients with HF atrophy compared with those with pure AM atrophy and those with normal volumes (p = 0.04). Prolonged postictal confusion was more often found with AM atrophy (p = 0.05). Memory impairment was more severe in patients with HF atrophy than in those with AM atrophy only or in those with normal volumes (p = 0.03). There were no significant differences among the five groups in the following parameters: age, duration of epilepsy, seizure frequency, and presence and type of aura. CONCLUSIONS: Prolonged postictal confusion appeared to be related to AM atrophy, in keeping with previous clinical observations. These patients also had a lower incidence of early febrile convulsions, older age at epilepsy onset, lower frequency of secondary GTCS, and lesser memory dysfunction compared with patients with hippocampal atrophy.     

Fronto-temporal-lobe atrophy in early-stage Alzheimer's disease identified using an improved detection methodology

Alzheimer's disease (AD) is associated with widespread brain atrophy including structures subserving memory. We applied an improved structural detection methodology to examine the less well known progression of atrophy in early-stage AD. We sought to i) longitudinally study volumetric differences in patients with early-stage AD and healthy volunteers; and ii) test the hypothesis that hippocampal volumes would be correlated with clinically relevant cognitive function. Seven patients and eleven healthy subjects underwent two structural MRI scans and neuropsychological assessments. Scans were normalised to a study-specific template and 'morphologically opened' to reduce tissue misclassification. Using brain-parcellation, patient atrophy was localised to left fusiform and parahippocampal gyri, whilst left hippocampal volumes were correlated with a cognitive performance measure. A whole-brain search methodology, showed that patients had reduced volumes including fronto-temporal regions bilaterally, in hippocampi and amygdalae and right cerebellum. Whole-brain correlational analyses revealed that cognitive performance was correlated with volumes of both hippocampi, superior temporal gyri and left insula. Neither group exhibited significant longitudinal volumetric changes. Utilising a novel methodology, we have shown that in early-stage AD, clinically relevant cognitive deficits are correlated with regionally specific grey-matter volumes, which are detectable at an early stage of the illness.     

Is ictal recording mandatory in temporal lobe epilepsy? Not when the interictal electroencephalogram and hippocampal atrophy coincide

OBJECTIVE: To investigate the concordance between scalp electroencephalogram (EEG) lateralization and side of hippocampal atrophy in patients with temporal lobe epilepsy (TLE). METHODS: We studied 184 consecutive patients with TLE without lesions other than those compatible with mesial temporal sclerosis. In this study, we studied specifically hippocampal atrophy and the results of scalp EEG investigation. Patients were classified according to the localization of interictal epileptiform discharges as unilateral, bilateral asymmetric, and bilateral symmetric. The EEG seizure onsets were also classified separately as unilateral, bilateral asymmetric, and bilateral symmetric. The hippocampal atrophy was determined by volumetric measurements using high-resolution magnetic resonance imaging (MRIVol). RESULTS: Only 3% of patients had discordance between the ictal and interictal EEG lateralizations; however, none of these had unilateral interictal EEG abnormalities. Interictal EEGs were considered unilateral in 62.0% of patients, bilateral asymmetric in 31.5%, and bilateral symmetric in 6.5%. Ictal EEGs were considered unilateral in 63.5% of patients, bilateral asymmetric in 30.0%, and bilateral symmetric in 6.5%. The MRIVol showed unilateral hippocampal atrophy in 60.9% of patients, bilateral asymmetric hippocampal atrophy in 19.0%, symmetric hippocampal atrophy in 3.8%, and normal volumes in 16.3%. There was a significant concordance between MRIVol lateralization and both interictal and ictal EEG lateralization (P<.001). All patients with unilateral hippocampal atrophy had concordant interictal and ictal EEG lateralization. Six (18.2%) of the 33 patients with bilateral asymmetric hippocampal atrophy had MRI lateralization discordant with EEG lateralization. CONCLUSIONS: We found a strong concordance between EEG and MRIVol lateralization in patients with TLE. Unilateral hippocampal atrophy predicted ipsilateral interictal epileptiform abnormalities and ipsilateral seizure onsets with no false lateralization. Previous studies in addition to the present series support that a concordant outpatient EEG evaluation in patients with TLE and unilateral hippocampal atrophy would obviate the need for inpatient EEG monitoring.     

Quantitative MRI volumetry of the entorhinal cortex in temporal lobe epilepsy.

The entorhinal cortex (Brodmann's area 28) is located at the anterior aspect of the parahippocampal gyrus ventral to the amygdala and the hippocampus. It is reciprocally interconnected with the hippocampus via glutamatergic pathways. We investigated whether the entorhinal cortex is damaged in human temporal lobe epilepsy (TLE). The volume of the entorhinal cortex was measured using magnetic resonance imaging (MRI) in 36 patients with cryptogenic TLE and in 21 controls. The mean volumes of the entorhinal cortex on the focal side did not differ from controls. In 11 of 36 patients, however, the entorhinal cortex volume was reduced by 25%. Entorhinal volume correlated with hippocampal volume in TLE (ipsilaterally, r= 0.454, P<0.01; contralaterally, r = 0.340, P<0.05). Further, 64% of patients with 25% entorhinal cortex damage had ipsilateral hippocampal atrophy. On the other hand, right focal TLE patients with hippocampal atrophy had a 19% volume reduction of the ipsilateral entorhinal cortex (P<0.05). The volume of the entorhinal cortex correlated with the duration of TLE (r= -0.335, P< 0.05). The present study indicates that the entorhinal cortex might be damaged in a subpopulation of patients with cryptogenic TLE. In most cases, volume reduction was associated with hippocampal damage. These data suggest that entorhinal damage contributes to the symptomatology in TLE.