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Aslam S, Rajeshkannan R, Sandya CJ, Sarma M, Gopinath S, Pillai A. Statistical asymmetry analysis of volumetric MRI and FDG PET in temporal lobe epilepsy. Epilepsy Behav 2022; 134:108810. [PMID: 35802989 DOI: 10.1016/j.yebeh.2022.108810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyze statistically derived threshold values of volumetric MRI and 18F fluorodeoxyglucose (FDG) PET asymmetry, independent of normative data, for non-invasive detection/exclusion of temporal lobe epilepsy (TLE). METHODS We retrospectively analyzed amygdalohippocampal volumetry and temporal FDG PET metabolism in 33 patients (age: 29.27 ± 8.56 years) who underwent surgery following Stereo-EEG implantation and had postsurgical seizure freedom lasting >12 months. The temporal lobe epilepsy group and the extratemporal lobe epilepsy (ETLE) group were compared. Percentage volume loss (PVL) was calculated from manually traced amygdalohippocampal volumetry whereas percentage metabolic loss (PML) was calculated from PET using amygdalohippocampal trace and temporal neocortical Brodmann areas (BA) template. RESULTS Receiver operating characteristic (ROC) curve analysis identified a cutoff hippocampal PVL of 4.21% as the minimum indicating probable hippocampal involvement in seizure onset, with sensitivity of 88.89% and the specificity of 100% (p < 0.001). Region of interest (ROI)-based PML values in PET imaging showed a significant correlation with the presence of TLE in the TLE group of patients and its absence in the ETLE group of patients. Region of interest curve analysis yielded PML cutoffs of 5.77% and 8.36%, respectively, for the hippocampus and BA 38 (temporopolar neocortex) to detect TLE with the sensitivity of 72.7% and specificity of 77.8%. CONCLUSION We describe statistical thresholds for asymmetry analysis of hippocampal volumetry and FDG PET to improve detection of TLE. These threshold parameters warrant further validation in prospective studies.
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Affiliation(s)
- Shameer Aslam
- Department of Neurology, Amrita Advanced Centre for Epilepsy, Amrita Institute of Medical Sciences & Research Center, Kochi, India
| | - Ramiah Rajeshkannan
- Department of Radiology, Amrita Advanced Centre for Epilepsy, Amrita Institute of Medical Sciences & Research Center, Kochi, India
| | - C J Sandya
- Department of Radiology, Amrita Advanced Centre for Epilepsy, Amrita Institute of Medical Sciences & Research Center, Kochi, India
| | - Manjit Sarma
- Department of Nuclear Medicine, Amrita Advanced Centre for Epilepsy, Amrita Institute of Medical Sciences & Research Center, Kochi, India
| | - Siby Gopinath
- Department of Neurology, Amrita Advanced Centre for Epilepsy, Amrita Institute of Medical Sciences & Research Center, Kochi, India
| | - Ashok Pillai
- Department of Neurosurgery, Amrita Advanced Centre for Epilepsy, Amrita Institute of Medical Sciences & Research Center, Kochi, India.
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The hippocampus: detailed assessment of normative two-dimensional measurements, signal intensity, and subfield conspicuity on routine 3T T2-weighted sequences. Surg Radiol Anat 2017; 39:1149-1159. [DOI: 10.1007/s00276-017-1843-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
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Lucarelli RT, Peshock RM, McColl R, Hulsey K, Ayers C, Whittemore AR, King KS. MR imaging of hippocampal asymmetry at 3T in a multiethnic, population-based sample: results from the Dallas Heart Study. AJNR Am J Neuroradiol 2013; 34:752-7. [PMID: 23139080 DOI: 10.3174/ajnr.a3308] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Asymmetry of the hippocampus is regarded as an important clinical finding, but limited data on hippocampal asymmetry are available for the general population. Here we present hippocampal asymmetry data from the Dallas Heart Study determined by automated methods and its relationship to age, sex, and ethnicity. MATERIALS AND METHODS 3D magnetization-prepared rapid acquisition of gradient echo MR imaging was performed in 2082 DHS-2 participants. The MR images were analyzed by using 2 standard automated brain-segmentation programs, FSL-FIRST and FreeSurfer. Individuals with imaging errors, self-reported stroke, or major structural abnormalities were excluded. Statistical analyses were performed to determine the significance of the findings across age, sex, and ethnicity. RESULTS At the 90th percentile, FSL-FIRST demonstrated hippocampal asymmetry of 9.8% (95% CI, 9.3%-10.5%). The 90th percentile of hippocampal asymmetry, measured by the difference in right and left hippocampi volume and the larger hippocampus, was 17.9% (95% CI, 17.0%-19.1%). Hippocampal asymmetry increases with age (P=.0216), men have greater asymmetry than women as shown by FSL-FIRST (P=.0036), but ethnicity is not significantly correlated with asymmetry. To confirm these findings, we used FreeSurfer. FreeSurfer showed asymmetry of 4.4% (95% CI, 4.3%-4.7%) normalized to total volume and 8.5% (95% CI, 8.3%-9.0%) normalized by difference/larger hippocampus. FreeSurfer also showed that hippocampal asymmetry increases with age (P=.0024) and that men had greater asymmetry than women (P=.03). CONCLUSIONS There is a significant degree of hippocampal asymmetry in the population. The data provided will aid in the research, diagnosis, and treatment of temporal lobe epilepsy and other neurologic disease.
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Affiliation(s)
- R T Lucarelli
- Department of Radiology, Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8896, USA
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Eroglu B, Kurul S, Cakmakçi H, Dirik E. The correlation of seizure characteristics and hippocampal volumetric magnetic resonance imaging findings in children with idiopathic partial epilepsy. J Child Neurol 2007; 22:348-53. [PMID: 17621511 DOI: 10.1177/0883073807301916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral volumetric measurements based on magnetic resonance imaging have been established as advanced morphometric techniques with anatomic and clinical utility in adults and children with epilepsy. This study investigated the cerebral and hippocampal volumes in children with idiopathic partial epilepsy to detect the factors correlated with volume reduction. Magnetic resonance imaging volumetric measurements were performed of the total cerebral and hippocampal formation volumes in 30 patients with idiopathic partial epilepsy between 3 to 18 years old. The cerebral and the total, right, and left hippocampal volumes of the study and control patients were detected using volumetric magnetic resonance imaging, and the volumes were compared between the 2 groups. In study patients, the correlation between volumetric findings and seizure characteristics was evaluated. The results suggested that children with idiopathic partial epilepsy had significant hippocampal volume reduction that was not influenced by the age of onset and the duration of epilepsy.
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Affiliation(s)
- Burçin Eroglu
- Department of Pediatric Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Roberti F, Potolicchio SJ, Caputy AJ. Tailored anteromedial lobectomy in the treatment of refractory epilepsy of the temporal lobe: Long term surgical outcome and predictive factors. Clin Neurol Neurosurg 2007; 109:158-65. [PMID: 16934920 DOI: 10.1016/j.clineuro.2006.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 06/21/2006] [Accepted: 07/22/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze long-term results and to determine prognostic factors on seizure outcome in a series of patients with temporal lobe epilepsy (TLE) who underwent anteromedial temporal lobectomy (AMTL). MATERIALS AND METHODS From 1995 to 1998 forty-two patients suffering from non-lesional TLE underwent tailored AMTL at our Institution. We retrospectively reviewed surgical results and calculated predictive factors of good outcome in the long term. RESULTS Sixty-four percent of patients were rendered seizure free (median follow up 60 months). Eleven cases (26.2%) had a significant reduction of disabling epileptic episodes. Poor seizure control was observed in four patients (9.5%). Overall surgical morbidity was 4.7%. Medial temporal sclerosis (MTS) was the most common histopathological finding (69% of cases). The presence of unilateral hippocampal abnormalities on qualitative MRI was significantly associated with excellent postoperative outcome (p<0.011). Qualitative preoperative MRI had a positive predictive value of 83% in detecting both MTS at pathological examination and excellent outcome. CONCLUSIONS Tailored AMTL is a safe and effective procedure in the treatment of selected patients with medically refractory TLE. Data from preoperative qualitative MRI well correlated with histopathological findings. The presence of unilateral hippocampal atrophy on qualitative MRI was predictive of excellent outcome in the long-term follow up.
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Affiliation(s)
- Fabio Roberti
- Department of Neurological Surgery, George Washington University Medical Center, Washington, DC, USA.
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Pedraza O, Bowers D, Gilmore R. Asymmetry of the hippocampus and amygdala in MRI volumetric measurements of normal adults. J Int Neuropsychol Soc 2004; 10:664-78. [PMID: 15327714 DOI: 10.1017/s1355617704105080] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2003] [Revised: 02/06/2004] [Indexed: 11/07/2022]
Abstract
Multiple studies have explored the relationship between MRI-based volumetric measurements of the hippocampus and amygdala, the degree of volumetric asymmetry of these structures, and symptom manifestation. However, considerable variability exists with regard to the reported volumetric values of these structures. The present study employed meta-analytic procedures to provide a systematic analysis of the normal population parameters of hippocampal and amygdala volumetric asymmetry as well as the absolute intrahemispheric volumes of these structures in normal adults. A literature review of studies published between 1990 and 2002 resulted in a representative sample of 82 studies (N = 3,564 participants) providing volumetric information of the hippocampus and 51 studies (N = 2,000 participants) providing volumetric information of the amygdala. Results revealed that both the hippocampus and the amygdala are reliably asymmetrical structures in normal adults, with larger right hippocampal (D = 0.21, p.001) and right amygdala (D = 0.09, p.01) volumes. Additional analyses indicated that differences in MRI magnet field strength and slice thickness values might differentially contribute to volumetric asymmetry estimates. These results expand on previous volumetric normative studies and may be relevant to investigators studying the clinical correlates of hippocampal and amygdala volumes.
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Affiliation(s)
- Otto Pedraza
- Department of Clinical and Health Psychology, University of Florida, Box 100165, Gainesville, Florida 32610, USA.
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Vemuri BC, Ye J, Chen Y, Leonard CM. Image registration via level-set motion: applications to atlas-based segmentation. Med Image Anal 2003; 7:1-20. [PMID: 12467719 DOI: 10.1016/s1361-8415(02)00063-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Image registration is an often encountered problem in various fields including medical imaging, computer vision and image processing. Numerous algorithms for registering image data have been reported in these areas. In this paper, we present a novel curve evolution approach expressed in a level-set framework to achieve image intensity morphing and a simple non-linear PDE for the corresponding coordinate registration. The key features of the intensity morphing model are that (a) it is very fast and (b) existence and uniqueness of the solution for the evolution model are established in a Sobolev space as opposed to using viscosity methods. The salient features of the coordinate registration model are its simplicity and computational efficiency. The intensity morph is easily achieved via evolving level-sets of one image into the level-sets of the other. To explicitly estimate the coordinate transformation between the images, we derive a non-linear PDE-based motion model which can be solved very efficiently. We demonstrate the performance of our algorithm on a variety of images including synthetic and real data. As an application of the PDE-based motion model, atlas based segmentation of hippocampal shape from several MR brain scans is depicted. In each of these experiments, automated hippocampal shape recovery results are validated via manual "expert" segmentations.
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Affiliation(s)
- B C Vemuri
- Department of CISE, University of Florida, Gainesville, FL 32611, USA.
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Marsh L, Sullivan EV, Morrell M, Lim KO, Pfefferbaum A. Structural brain abnormalities in patients with schizophrenia, epilepsy, and epilepsy with chronic interictal psychosis. Psychiatry Res 2001; 108:1-15. [PMID: 11677063 DOI: 10.1016/s0925-4927(01)00115-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Chronic interictal psychotic syndromes, often resembling schizophrenia, develop in some patients with epilepsy. Although widespread brain abnormalities are recognized as characteristic of schizophrenia, prevailing but controversial hypotheses on the co-occurrence of epilepsy and psychosis implicate left temporal lobe pathology. In this study, quantitative MRI methods were used to address the regional specificity of structural brain abnormalities in patients with epilepsy plus chronic interictal psychosis (E+PSY, n=9) relative to three comparison groups: unilateral temporal lobe epilepsy without chronic psychosis (TLE, n=18), schizophrenia (SCZ, n=46), and healthy control subjects (HC, n=57). Brain measures, derived from a coronal spin-echo MRI sequence, were adjusted for age and cerebral volume. Relative to HC, all patient groups had ventricular enlargement and smaller temporal lobe, frontoparietal, and superior temporal gyrus gray matter volumes, with the extent of these abnormalities greatest in E+PSY. Only TLE had temporal lobe white matter deficits, as well as smaller hippocampi, which were ipsilateral to the seizure focus. Structural brain abnormalities in E+PSY are not restricted to the left temporal lobe. The confluence of cortical gray matter deficits in E+PSY and SCZ suggests salience to chronic psychosis.
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Affiliation(s)
- L Marsh
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical School, Stanford, CA, USA.
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Eisenschenk S, Gilmore RL, Cibula JE, Roper SN. Lateralization of temporal lobe foci: depth versus subdural electrodes. Clin Neurophysiol 2001; 112:836-44. [PMID: 11336899 DOI: 10.1016/s1388-2457(01)00517-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Definitive localization of an epileptic focus correlates with a favorable outcome following epilepsy surgery. This study was undertaken to determine the incremental value of data yielded for surgical decision making when using subdural electrodes alone and in addition to depth electrodes for temporal lobe epilepsy. METHODS Standardized placement for intracranial electrodes included: (1) longitudinal placement of bilateral temporal lobe depth electrodes; (2) bilateral subtemporal subdural strips; and (3) bilateral orbitofrontal subdural strips. Sixty-three events were randomly reviewed for: (1) subdural electrodes alone; and (2) depth electrodes in conjunction with subdural electrodes. RESULTS Of the 63 seizures, 54 (85.7%) demonstrated congruent lateralization to ipsilateral subtemporal subdural strip electrodes (based on depth electrode localization) when subdural strip electrodes were utilized alone. In 3 of 22 patients, 7 seizures demonstrated 'false localization' on subdural electrode analysis alone when compared with depth recording and post-surgical outcome. For these 3 patients, retrospective review of neuroimaging demonstrated suboptimal ipsilateral placement of subtemporal subdural electrodes with the most mesial electrode lateral to the collateral sulcus. Four additional patients had suboptimal placement of subtemporal subdural electrodes. Two of these 4 patients had congruent localization with subdural electrodes to ipsilateral depth electrodes despite suboptimal placement. Subtemporal subdural electrodes accurately localized for all seizures from the mesial temporal lobe when the mesial electrodes of the subtemporal subdural strip recorded mesial to the collateral sulcus from the parahippocampal region. CONCLUSION We conclude that although there are high concordance rates between subdural and depth electrodes, localization of seizure onset based on subdural strip electrodes alone may result in inaccurate focus identification with potential for possible suboptimal treatment of temporal lobe epilepsy. When subtemporal subdural electrodes provide recording from the parahippocampal region, there is accurate localization of the seizure focus. If suboptimal placement occurs lateral to the collateral sulcus, the electroencephalographer cannot make a definitive identification of the seizure focus.
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Affiliation(s)
- S Eisenschenk
- Department of Neurology, University of Florida, University of Florida Brain Institute, 100 South Newell Drive, Room L3-100, Gainesville, FL 32601-0236, USA.
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Lawson JA, Vogrin S, Bleasel AF, Cook MJ, Bye AM. Cerebral and cerebellar volume reduction in children with intractable epilepsy. Epilepsia 2000; 41:1456-62. [PMID: 11077460 DOI: 10.1111/j.1528-1157.2000.tb00122.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Adult epilepsy studies have demonstrated cerebral and cerebellar volume reduction beyond the epileptogenic zone, correlating this with an inferior surgical outcome. We determined whether brain volumes were reduced in childhood epilepsy and the significance of this. METHODS Cerebral, cerebellar, and hippocampal volumes were measured by quantitative magnetic resonance imaging on 112 children (ages 4-18) with epilepsy syndrome determined by video-EEG telemetry. Eighty-seven had partial epilepsy and 25 had generalized epilepsy or indeterminate syndrome. Normative volumes were obtained from 44 child controls from the community. RESULTS A significant reduction in cerebral (12.6%) and cerebellar (7.9%) volume was present in the epilepsy group compared with controls. Analysis of subgroups revealed that cerebral volume was significantly decreased in frontal lobe and nonlocalized partial epilepsies. The mean hippocampal ratio of 0.73 for mesial temporal lobe epilepsy was significantly less than for all other syndromes and controls. There was no difference in the rate of hippocampal volume reduction between syndromes. There was a significant correlation between IQ and cerebral and cerebellar volume, but not duration or age of onset of epilepsy. CONCLUSIONS Cerebral and cerebellar volume reduction is common in intractable epilepsy syndromes of childhood. These cross-sectional data suggest that brain volume reduction is present at epilepsy onset and is not a result of intractable seizures. Hippocampal asymmetry is more sensitive than volume reduction as a marker for mesial temporal lobe epilepsy, but neither measure is specific.
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Affiliation(s)
- J A Lawson
- Department of Paediatric Neurology, Sydney Children's Hospital & School of Paediatrics, University of New South Wales, Randwick, New South Wales
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Lawson JA, Nguyen W, Bleasel AF, Pereira JK, Vogrin S, Cook MJ, Bye AM. ILAE-defined epilepsy syndromes in children: correlation with quantitative MRI. Epilepsia 1998; 39:1345-9. [PMID: 9860072 DOI: 10.1111/j.1528-1157.1998.tb01335.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The role of quantitative magnetic resonance imaging (MRI) in evaluation of childhood epilepsy remains poorly defined, with minimal published data. Previous work from our center questioned the specificity of hippocampal asymmetry (HA) in an outpatient group whose epilepsy was defined by using clinical and interictal data only. By using childhood volunteer controls and defining epilepsy syndromes using video-EEG monitoring, we readdressed the utility of HA in differentiating mesial temporal lobe epilepsy (MTLE) from other partial and generalized epileptic syndromes in children. METHODS Seventy children were enrolled; entry criteria were age younger than 18 years with predominant seizure type recorded on video-EEG telemetry with volumetric MRI in all cases. Thirty healthy child volunteers had volumetric MRI. Epilepsy syndrome classification was according to ILAE. RESULTS Control data revealed symmetric hippocampi, mean smaller/larger ratio of 0.96 (0.95-0.97, 95% CI) with no gender or right/left predominance. Overall 23% of patients had significant HA. Mean hippocampal ratio for MTLE was 0.78 (95% CI, 0.70-0.86), significantly lower than controls and from all other epilepsy syndromes. HA was highly specific (85%) to the syndrome of MTLE. Other potential epileptogenic lesions were found in 27 (39%) patients, lowest yield in frontal and mesial temporal syndromes. Dual pathology was present in 10% of patients. There was no significant association between HA and risk factors. CONCLUSIONS In this study, we found that HA in children with a well-defined epilepsy syndrome is highly sensitive and specific for MTLE. Whether this will correlate with surgical outcome, as in adults, is the subject of ongoing study.
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Affiliation(s)
- J A Lawson
- Sydney Children's Hospital, Randwick, New South Wales, Australia
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Lawson JA, Cook MJ, Bleasel AF, Nayanar V, Morris KF, Bye AM. Quantitative MRI in outpatient childhood epilepsy. Epilepsia 1997; 38:1289-93. [PMID: 9578524 DOI: 10.1111/j.1528-1157.1997.tb00066.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE In adult studies, MRI volumetrics is a proven technique in presurgical assessment of epilepsy. Hippocampal volume loss is maximal in the syndrome of mesial temporal lobe epilepsy. We aimed (a) to validate this methodology in a pediatric outpatient epilepsy population (b) to determine the relationship of hippocampal asymmetry (HA) to epileptic syndromes and risk factors. METHODS Two neurologists classified the epileptic syndrome in 79 pediatric outpatients, according to the International Classification of Epilepsies and Epileptic Syndromes (ILAE). Hippocampal volumetrics were performed in all patients. HA was defined according to adult control values. RESULTS Inter-rater variability on measurement of HA was very small (Correlation of test retest of 0.97 on 17 children <3 years old). The rate of HA was 44/79 (57%). In 21 patients, (27%) potentially epileptogenic lesions (other than HA) were identified (cerebral dysgenesis n = 11). HA was present in 9/15 (60%) of temporal lobe epilepsy and in 15/28 (54%) extratemporal onset epilepsy and 5/11 (46%) of generalized symptomatic epilepsy. Analysis confined to <13 years also showed HA was not specific for epileptic syndrome. There was no significant association of febrile convulsions (13%) with HA or temporal lobe epilepsy. CONCLUSIONS There is a high incidence of HA in childhood epilepsy. HA was not confined to clinically defined temporal lobe epilepsy. The poor correlation of epileptic syndrome to quantitative MRI findings may be due to the inadequacies of epilepsy classification in the younger child, with the clinical semiology providing misleading localizing information. Normative childhood data for hippocampal volumes and symmetry is needed.
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Affiliation(s)
- J A Lawson
- Department of Neurology, Sydney Children's Hospital, Randwick, NSW, Australia
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Cendes F, Caramanos Z, Andermann F, Dubeau F, Arnold DL. Proton magnetic resonance spectroscopic imaging and magnetic resonance imaging volumetry in the lateralization of temporal lobe epilepsy: a series of 100 patients. Ann Neurol 1997; 42:737-46. [PMID: 9392573 DOI: 10.1002/ana.410420510] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Surgery is a safe and effective treatment for drug-resistant temporal lobe epilepsy (TLE). However, bilateral electroencephalographic (EEG) abnormalities are frequently present, making presurgical lateralization difficult. New magnetic resonance (MR) techniques can help; proton magnetic resonance spectroscopic imaging (MRSI) can detect and quantify focal neuronal damage or dysfunction based on reduced signals from the neuronal marker N-acetylaspartate, and magnetic resonance imaging (MRI)-based measurements of amygdala-hippocampal volumes (MRIVol) can improve the detection of atrophy of these structures. We performed proton MRSI and MRIVol in 100 consecutive patients with medically intractable TLE to determine how well these techniques agreed with the lateralization by extensive EEG investigation. We found that the EEG, MRSI, and MRIVol findings were highly concordant. The MRSI was abnormal in 99 of 100 patients (bilateral in 54%). The MRIVol was abnormal in 86 of 98 patients (bilateral in 28%). We obtained lateralization in 83% of patients using MRIVol alone, in 86% using MRSI alone, and in 90% by combining MRSI and MRIVol (vs 93% lateralization by EEG). MRSI was abnormal in 12 patients with normal MRIVol. The combination of proton MRSI and MRIVol can lateralize TLE accurately and noninvasively in the great majority of patients. By reducing reliance on EEG, these imaging techniques could reduce prolonged presurgical evaluation and make seizure surgery available to more patients.
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Affiliation(s)
- F Cendes
- Montreal Neurological Institute, McGill University, Quebec, Canada
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Caplan R, Arbelle S, Guthrie D, Komo S, Shields WD, Hansen R, Chayasirisobhon S. Formal thought disorder and psychopathology in pediatric primary generalized and complex partial epilepsy. J Am Acad Child Adolesc Psychiatry 1997; 36:1286-94. [PMID: 9291731 DOI: 10.1097/00004583-199709000-00022] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine whether formal thought disorder and psychopathology occurred in children with complex partial seizures (CPS) rather than children with primary generalized epilepsy with absences (PGE) or nonepileptic children. METHOD Formal thought disorder was coded in 30 children with CPS, 24 children with PGE, and 61 nonepileptic children, and structured interview-based psychiatric diagnoses were obtained for the epileptic subjects. RESULTS The CPS subjects had significantly more illogical thinking than the PGE and nonepileptic children. The severity of their illogical thinking was related to global cognitive dysfunction and a schizophrenia-like psychosis. Age of onset and seizure control, however, were significantly associated with the severity of illogical thinking in the PGE group. One or more psychiatric diagnoses were found in 63% of the CPS and 54% of the PGE patients, particularly if they had global cognitive deficits. CONCLUSION Illogical thinking, associated with cognitive dysfunction or schizophrenia-like symptoms, might be a feature of pediatric CPS. Psychopathology might be related to global cognitive dysfunction in pediatric CPS and PGE.
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Affiliation(s)
- R Caplan
- Department of Psychiatry, UCLA, USA
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Quigg M, Bertram EH, Jackson T, Laws E. Volumetric magnetic resonance imaging evidence of bilateral hippocampal atrophy in mesial temporal lobe epilepsy. Epilepsia 1997; 38:588-94. [PMID: 9184605 DOI: 10.1111/j.1528-1157.1997.tb01144.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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 ipsilateral 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.
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Affiliation(s)
- M Quigg
- Department of Neurology, University of Virginia, Charlottesville 22908, USA
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Fukuzako H, Yamada K, Kodama S, Yonezawa T, Fukuzako T, Takenouchi K, Kajiya Y, Nakajo M, Takigawa M. Hippocampal volume asymmetry and age at illness onset in males with schizophrenia. Eur Arch Psychiatry Clin Neurosci 1997; 247:248-51. [PMID: 9444493 DOI: 10.1007/bf02900302] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To determine whether there are disturbances of hippocampal volume asymmetry in schizophrenic patients, we obtained contiguous, 1-mm-thick magnetic resonance images in 28 males with chronic schizophrenia and in 28 age-matched healthy males. The schizophrenic patients showed a bilateral reduction in volume of the hippocampal formation (HF; left 7.0%; right 8.7%). This reduction was significantly associated with the severity of disorganization syndrome (P < 0.0005). A significant asymmetry in the HF volume was found in the control subjects (P = 0.006), but not in the patients (P = 0.40). There was a significant positive correlation between the asymmetry index and the patient's age at the onset of schizophrenia (r = 0.46, P = 0.01). Results indicate that a disturbance in the normal asymmetry of the HF may be a characteristic in schizophrenia, particularly in patients with an early onset of the illness.
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Affiliation(s)
- H Fukuzako
- Department of Neuropsychiatry, Faculty of Medicine, Kagoshima University, Japan
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Breier JI, Leonard CM, Bauer RM, Roper S, Lucas TH, Gilmore RL. Quantified volumes of temporal lobe structures in patients with epilepsy. J Neuroimaging 1996; 6:108-14. [PMID: 8634483 DOI: 10.1111/jon199662108] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The T1-weighted volumetric magnetic resonance images of 31 patients with intractable temporal lobe epilepsy, and 13 control subjects matched for age and sex, were subjected to semiautomated threshold analysis. The method used proved to be relatively fast and reliable. An index of temporal lobe interhemispheric asymmetry was extracted by thresholding high-signal (white matter) pixels. Patients had significantly more asymmetrical indices for white matter and hippocampal volumes that did control subjects, and the two indices were significantly correlated, providing evidence for the validity of the white matter index. Differences in both indices were consistent with decreased tissue on the side of the focus. In classification analyses a combination of these two indices correctly predicted the side of focus at a greater rate than did either used alone. Findings provide support for the hypothesis that seizure activity is associated with atrophy in both mesial and lateral temporal lobe structures.
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Affiliation(s)
- J I Breier
- Department of Clinical and Health Psychology, University of Florida College of Medicine, Gainesville, USA
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