Impaired facial emotion recognition in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS): Side and age at onset matters

To define the determinants of impaired facial emotion recognition (FER) in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS), we examined 76 patients with unilateral MTLE-HS, 36 prior to antero-mesial temporal lobectomy (AMTL) and 40 after AMTL, and 28 healthy control subjects with a FER test consisting of 60 items (20 each for anger, fear, and happiness). Mean percentages of the accurate responses were calculated for different subgroups: right vs. left MTLE-HS, early (age at onset <6 years) vs. late-onset, and before vs. after AMTL. After controlling for years of education, duration of epilepsy and number of antiepileptic drugs (AEDs) taken, on multivariate analysis, fear recognition was profoundly impaired in early-onset right MTLE-HS patients compared to other MTLE patients and control subjects. Happiness recognition was significantly better in post-AMTL MTLE-HS patients compared to pre-AMTL patients while anger and fear recognition did not differ. We conclude that patients with right MTLE-HS with age at seizure onset <6 years are maximally predisposed to impaired fear recognition. In them, right AMTL does not further worsen FER abilities. Longitudinal studies comparing FER in the same patients before and after AMTL will be required to refine and confirm our cross-sectional observations.     

Emotion recognition in temporal lobe epilepsy: A systematic review

There is increasing interest in the understanding of emotion recognition deficits in temporal lobe epilepsy (TLE), the most common form of focal epilepsies. There are conflicting reports about impairments for different emotions in right and left temporal lobe epilepsy patients. A systematic review and a narrative synthesis was conducted for studies investigating emotion recognition (ER) in TLE. Embase, MEDLINE, PsychINFO and Pubmed were searched from 1990 to March 2015 and reference lists were reviewed. 996 citations were identified and 43 studies were finally included.ER deficits are consistently observed across studies. A fear recognition deficit is always reported, followed by deficits in sadness and disgust recognition. Deficits are observed across visual and auditory domains. Conflicting evidence is present concerning the severity of ER deficits in right and left TLE. Studies on anterior temporal lobectomy report data similar to that observed in pre-surgical patients.Current evidence supports the conclusion that recognition of negative emotions is commonly impaired in TLE, particularly for fear, and in the visual domain. Future work should focus on more ecologically valid test, on longitudinal studies to assess the role of anterior temporal lobectomy, and to correlate ER measures to social functioning in everyday life.     

Marked accumulation of oligodendroglia‐like cells in temporal lobe epilepsy with amygdala enlargement and hippocampal sclerosis

Although an increasing number of cases of temporal lobe epilepsy (TLE) with ipsilateral amygdala enlargement (AE) have been reported, there are few pathological reports, and no clear consensus has been established. Oligodendroglia or oligodendroglia‐like cells (OLCs) have recently attracted attention in epilepsy studies. Here, we report the clinical and pathological findings of a 40‐year‐old male TLE patient with AE and hippocampal sclerosis, in whom histopathological study demonstrated remarkable clustering of OLCs around the uncus. The patient began to have refractory seizures at the age of 14, and preoperative MRI revealed left amygdala enlargement and left hippocampal atrophy. Other examinations were consistent with left mesial temporal epileptogenicity. He underwent surgical resection and achieved seizure freedom. Histopathological study of the amygdala showed swollen neurons with relatively large bodies and thick neurites, accompanied by vacuolar degeneration in the background. Additionally, there were marked clusters of OLCs with round nuclei and densely stained chromatin around the uncus. The OLCs were Olig2‐positive. In the hippocampus, severe cell loss in CA1 and granule cell dispersion in the dentate gyrus were found. These findings may provide some insights for further pathological investigations of TLE with non‐neoplastic AE.     

Peri‐ictal water drinking: a rare automatic behaviour in temporal lobe epilepsy

Peri‐ictal water drinking (PIWD) has been reported as the action of drinking during or within two minutes of an electroclinical seizure. It is considered a peri‐ictal vegetative symptom, evident both during childhood and adulthood epilepsy. The aim of this paper was to describe the clinical and electroencephalographic features of two new adult subjects suffering from symptomatic temporal lobe epilepsy with episodes of PIWD recorded by VIDEO‐EEG and to review literature data in order to better define this peculiar event during seizures, a rare and probably underestimated semiological sign. To date, 51 cases with focal epilepsy and seizures associated with PIWD have been reported. All patients presented with temporal lobe epilepsy. All cases but one had symptomatic epilepsy. Most of the patients had an involvement of the right hemisphere. Water drinking was reported as an ictal sign in the majority of patients, and less frequently was reported as postictal. We believe that PIWD might be considered a rare automatic behaviour, like other automatisms. Automatisms are more frequently described in patients with temporal lobe epilepsy. PIWD was reported also to have lateralizing significance in the non‐dominant temporal lobe, however, because of its rarity, this finding remains unclear.     

Temporal lobe epilepsy – not a consequence of childhood febrile convulsions in Denmark

Temporal lobe epilepsy in particular has been considered a consequence of childhood febrile convulsions. Previous studies have dealt with populations of epileptic children. This retrospective, follow-up study concerns 362 children with a primary diagnosis of febrile convulsions. 4% developed epilepsy. When followed into early adulthood one half of those remitted. The incidence of temporal lobe epilepsy among the non-rermitters did not differ from that of a random population of epileptics.     

Visual and auditory socio‐cognitive perception in unilateral temporal lobe epilepsy in children and adolescents: a prospective controlled study

Aim. A high rate of abnormal social behavioural traits or perceptual deficits is observed in children with unilateral temporal lobe epilepsy. In the present study, perception of auditory and visual social signals, carried by faces and voices, was evaluated in children or adolescents with temporal lobe epilepsy. Methods. We prospectively investigated a sample of 62 children with focal non‐idiopathic epilepsy early in the course of the disorder. The present analysis included 39 children with a confirmed diagnosis of temporal lobe epilepsy. Control participants (72), distributed across 10 age groups, served as a control group. Our socio‐perceptual evaluation protocol comprised three socio‐visual tasks (face identity, facial emotion and gaze direction recognition), two socio‐auditory tasks (voice identity and emotional prosody recognition), and three control tasks (lip reading, geometrical pattern and linguistic intonation recognition). All 39 patients also benefited from a neuropsychological examination. Results. As a group, children with temporal lobe epilepsy performed at a significantly lower level compared to the control group with regards to recognition of facial identity, direction of eye gaze, and emotional facial expressions. We found no relationship between the type of visual deficit and age at first seizure, duration of epilepsy, or the epilepsy‐affected cerebral hemisphere. Deficits in socio‐perceptual tasks could be found independently of the presence of deficits in visual or auditory episodic memory, visual non‐facial pattern processing (control tasks), or speech perception. A normal FSIQ did not exempt some of the patients from an underlying deficit in some of the socio‐perceptual tasks. Conclusion. Temporal lobe epilepsy not only impairs development of emotion recognition, but can also impair development of perception of other socio‐perceptual signals in children with or without intellectual deficiency. Prospective studies need to be designed to evaluate the results of appropriate re‐education programs in children presenting with deficits in social cue processing.     

Hemodynamic correlates of emotion regulation in frontal lobe epilepsy patients and healthy participants

The ability to regulate emotions is indispensable for maintaining psychological health. It heavily relies on frontal lobe functions which are disrupted in frontal lobe epilepsy. Accordingly, emotional dysregulation and use of maladaptive emotion regulation strategies have been reported in frontal lobe epilepsy patients. Therefore, it is of clinical and scientific interest to investigate emotion regulation in frontal lobe epilepsy. We studied neural correlates of upregulating and downregulating emotions toward aversive pictures through reappraisal in 18 frontal lobe epilepsy patients and 17 healthy controls using functional magnetic resonance imaging. Patients tended to report more difficulties with impulse control than controls. On the neural level, patients had diminished activity during upregulation in distributed left‐sided regions, including ventrolateral and dorsomedial prefrontal cortex, angular gyrus and anterior temporal gyrus. Patients also showed less activity than controls in the left precuneus for upregulation compared to downregulation. Unlike controls, they displayed no task‐related activity changes in the left amygdala, whereas the right amygdala showed task‐related modulations in both groups. Upregulation‐related activity changes in the left inferior frontal gyrus, insula, orbitofrontal cortex, anterior and posterior cingulate cortex, and precuneus were correlated with questionnaire data on habitual emotion regulation. Our results show that structural or functional impairments in the frontal lobes disrupt neural mechanisms underlying emotion regulation through reappraisal throughout the brain, including posterior regions involved in semantic control. Findings on the amygdala as a major target of emotion regulation are in line with the view that specifically the left amygdala is connected with semantic processing networks.     

颞叶癫痫患者情绪及认知功能研究

目的调查颞叶癫痫(TLE)患者情绪及认知功能状况,分析相关的临床影响因素。方法对30例颞叶癫痫患者以及30例年龄、性别和受教育程度无差异的健康对照进行信息采集、神经心理学量表调查和统计学分析。结果与对照组相比,TLE组中出现焦虑情绪个体比例更高(P0.01);MoCA、WAIS-RC知识、TMT_B以及BDST评分较低,差异具有统计学意义(P0.05)。病程、癫痫家族史与MoCA评分及起病年龄与WAIS-RC知识评分之间均具有线性回归关系(决定系数分别为R~2=0.325和R~2=0.137,P0.05)。结论 TLE患者群体相较于正常人群更容易出现焦虑情绪,并且可出现整体智能、短时记忆、远期记忆能力、注意力和执行控制能力下降。对TLE患者,尤其对病程长、起病早和有家族史的患者,早期进行神经心理学评估将有利于及早发现认知功能损伤,实行有效干预。     

A study of the relationship between the seizure focus and 1H-MRS in temporal lobe epilepsy and frontal lobe epilepsy

Several studies of temporal lobe epilepsy (TLE) patients have investigated the relationship between the seizure focus and 1H magnetic resonance spectroscopy (1H-MRS). There have also been a few reports in other types of partial epilepsy. We examined the relationship between the seizure focus and the reduction in N-acetylaspartate: creatine (NAA : Cr) ratio using 1H-MRS in both TLE and frontal lobe epilepsy (FLE) patients. We studied 21 patients with unilateral TLE and seven patients with unilateral FLE. We used a 1.5 Tesla magnetic resonance unit (Signa Horizon; General Electric). Approximately 15 x 15 x 20 mm3 voxel of interest (VOI) was placed over the anterior portion of the bilateral hippocampus in the TLE patients, and the anterodorsal position of bilateral frontal lobe in the FLE patients. The seizure focus was identified by interictal scalp electro-encephalogram (EEG). In the TLE patients the NAA : Cr ratios were reduced in the seizure focus, while in the FLE patients they were not always reduced in the seizure focus. In the TLE patients the coincidence rate between the seizure focus and the reduction in the NAA:Cr ratio was 90% (19 of 21 patients), while in the FLE patients the coincidence rate was only 57% (four of seven patients).     

Impaired facial expression recognition in children with temporal lobe epilepsy: impact of early seizure onset on fear recognition

The amygdala has been implicated in the recognition of facial emotions, especially fearful expressions, in adults with early-onset right temporal lobe epilepsy (TLE). The present study investigates the recognition of facial emotions in children and adolescents, 8–16 years old, with epilepsy. Twenty-nine subjects had TLE (13 right, 16 left) and eight had fronto-central epilepsy (FCE). Each was matched on age and gender with a control subject. Subjects were asked to label the emotions expressed in pictures of children's faces miming five basic emotions (happiness, sadness, fear, disgust and anger) or neutrality (no emotion). All groups of children with epilepsy performed less well than controls. Patterns of impairment differed according to the topography of the epilepsy: the left-TLE (LTLE) group was impaired in recognizing fear and neutrality, the right-TLE (RTLE) group was impaired in recognizing disgust and, the FCE group was impaired in recognizing happiness. We clearly demonstrated that early seizure onset is associated with poor recognition of facial expression of emotion in TLE group, particularly for fear. Although right-TLE and left-TLE subjects were both impaired in the recognition of facial emotion, their psychosocial adjustment, as measured by the CBCL questionnaire [Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and Youth Self-report. Burlington, VT: University of Vermont Department of Psychiatry], showed that poor recognition of fearful expressions was related to behavioral disorders only in children with right-TLE. Our study demonstrates for the first time that early-onset TLE can compromise the development of recognizing facial expressions of emotion in children and adolescents and suggests a link between impaired fear recognition and behavioral disorders.     

fMRI study of mesial temporal lobe epilepsy using amplitude of low‐frequency fluctuation analysis

Various functional imaging tools have been used to detect epileptic activity in the neural network underlying mesial temporal lobe epilepsy (mTLE). In the present fMRI study, a data‐driven approach was employed to map interictal epileptic activity in mTLE patients by measuring the amplitude of low‐frequency fluctuation (ALFF) of the blood oxygen level‐dependent (BOLD) signal. Twenty‐four left mTLE patients and 26 right mTLE patients were investigated by comparing with 25 healthy subjects. In the patients, the regions showing increased ALFF were consistently distributed in the mesial temporal lobe, thalamus, and a few of other cortical and subcortical structures composing a mesial temporal epilepsy network proposed previously, while the regions showing decreased ALFF were mostly located in the areas of so‐called default‐mode network. Data of simultaneous EEG‐fMRI from a portion of the patients suggested that the increases in ALFF might be associated with the interictal epileptic activity. Individual analyses based on statistic parametric mapping revealed a moderate sensitivity and a fairly high specificity for the lateralization of unilateral mTLE. We conclude that the ALFF analysis may provide a useful tool in fMRI study of epilepsy. Hum Brain Mapp, 2010. © 2010 Wiley‐Liss, Inc.     

Long‐term health‐related quality of life in drug‐resistant temporal lobe epilepsy after anterior temporal lobectomy

Epilepsy surgery is beneficial to patients suffering from drug‐resistant temporal lobe epilepsy in the short term, but fewer reports of long‐term outcomes have been published. To clarify the long‐term outcomes of seizure control and health‐related quality of life after epilepsy surgery, we enrolled 48 patients suffering from drug‐resistant temporal lobe epilepsy. All of the patients received comprehensive presurgical evaluations, including the Quality of Life in Epilepsy Inventory‐89 (QOLIE‐89) questionnaire to measure their health‐related quality of life. Among the patients, 28 patients received surgery (surgical group) and 20 patients remained under medication (medical group). Eight years later, the seizure frequency and QOLIE‐89 were evaluated. The seizure‐free rate was much higher in the surgical group (53.6%) than in the medical group (5%), eight years after the initial evaluation. The follow‐up QOLIE‐89 score was significantly higher in the surgical group than in the medical group. Moreover, the seizure frequency inversely correlated to the QOLIE‐89 score, regardless of the treatment group. Our results provide evidence that epilepsy surgery confers benefits with respect to seizure control and health‐related quality of life for drug‐resistant temporal lobe epilepsy patients based on long‐term follow‐up.     

Understanding the basic mechanisms underlying seizures in mesial temporal lobe epilepsy and possible therapeutic targets: a review

Despite years of research, epilepsy remains a poorly understood disorder. In the past several years, work has been conducted on a variety of projects with the goal of better understanding the pathogenesis and progression of mesial temporal lobe epilepsy (MTLE), in particular, and how to exploit those properties to generate innovative therapies for treatment of refractory epilepsies. This review seeks to give an overview of common morphological and biochemical changes associated with epilepsy and proposed treatments to address those changes. Furthering the understanding of ictogenesis and epileptogenesis remains an important goal for scientists seeking to find more effective treatments for MTLE.     

Temporal encephalocele: a novel indication for magnetic resonance‐guided laser interstitial thermal therapy for medically intractable epilepsy

Temporal encephalocele (TE) is a rare but surgically treatable/curable cause of temporal lobe epilepsy (TLE). The surgical intervention varies from local disconnection to extensive anterior temporal lobectomy and amygdalohippocampectomy (ATL/AH). Magnetic resonance‐guided laser interstitial thermal therapy (MRgLITT) has evolved as a minimally invasive alternative for intractable epilepsy with good results, however, application of MRgLITT for intractable pediatric epilepsy secondary to TE has not been reported. We present a detailed technical report and clinical experience of MRgLITT in two adolescent children with medically intractable TLE secondary to TE. Pre‐surgical evaluation revealed anterior inferior TE with concordant clinico‐electrophysiological data. Both the patients underwent MRgLITT after review with the institutional multidisciplinary epilepsy team and discussion with the patient and the family. Both the patients were discharged on post‐operative day one and have been seizure‐free since the procedure at the last follow‐up visit at 18 months and 6 months, respectively. The present series demonstrates first‐ever clinical and technical experience of MRgLITT for TE with intractable pediatric epilepsy. The excellent post‐operative seizure outcome and favorable postoperative course support MRgLITT as the first line of surgical intervention for TE with intractable TLE and broadens the application of MRgLITT.     

Temporal lobe epilepsy surgery and the quest for optimal extent of resection: a review

The efficacy of surgery to treat drug-resistant temporal lobe epilepsy (TLE) has been demonstrated in a prospective randomized trial. It remains controversial which resection method gives best results for seizure freedom and neuropsychological function. This review of 5 3 studies addressing extent of resection in surgery for TLE identified seven prospective studies of which four were randomized. There is considerable variability between the intended resection and the volumetrically assessed end result. Even leaving hippocampus or amygdalum behind can result in seizure freedom rates around 50%. Most authors found seizure outcome in selective amygdalohippocampectomy (SAH) to be similar to that of lobectomy and there is considerable evidence for better neuropsychological outcome in SAH. Studies varied in the relationship between extent of mesial resection and seizure freedom, most authors finding no positive correlation to larger mesial resection. Electrophysiological tailoring saw no benefit from larger resection in 6 of 10 studies. It must be concluded that class I evidence concerning seizure outcome related to type and extent of resection of mesial temporal lobe structures is rare. Many studies are only retrospective and do not use MRI volumetry. SAH appears to have similar seizure outcome and a better cognitive outcome than TLR. It remains unclear whether a larger mesial resection extent leads to better seizure outcome.