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Shakhatreh L, Sinclair B, McLean C, Lui E, Morokoff AP, King JA, Chen Z, Perucca P, O'Brien TJ, Kwan P. Amygdala enlargement in temporal lobe epilepsy: Histopathology and surgical outcomes. Epilepsia 2024; 65:1709-1719. [PMID: 38546705 DOI: 10.1111/epi.17968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Amygdala enlargement is detected on magnetic resonance imaging (MRI) in some patients with drug-resistant temporal lobe epilepsy (TLE), but its clinical significance remains uncertain We aimed to assess if the presence of amygdala enlargement (1) predicted seizure outcome following anterior temporal lobectomy with amygdalohippocampectomy (ATL-AH) and (2) was associated with specific histopathological changes. METHODS This was a case-control study. We included patients with drug-resistant TLE who underwent ATL-AH with and without amygdala enlargement detected on pre-operative MRI. Amygdala volumetry was done using FreeSurfer for patients who had high-resolution T1-weighted images. Mann-Whitney U test was used to compare pre-operative clinical characteristics between the two groups. The amygdala volume on the epileptogenic side was compared to the amygdala volume on the contralateral side among cases and controls. Then, we used a two-sample, independent t test to compare the means of amygdala volume differences between cases and controls. The chi-square test was used to assess the correlation of amygdala enlargement with (1) post-surgical seizure outcomes and (2) histopathological changes. RESULTS Nineteen patients with and 19 patients without amygdala enlargement were studied. Their median age at surgery was 38 years for cases and 39 years for controls, and 52.6% were male. There were no statistically significant differences between the two groups in their pre-operative clinical characteristics. There were significant differences in the means of volume difference between cases and controls (Diff = 457.2 mm3, 95% confidence interval [CI] 289.6-624.8; p < .001) and in the means of percentage difference (p < .001). However, there was no significant association between amygdala enlargement and surgical outcome (p = .72) or histopathological changes (p = .63). SIGNIFICANCE The presence of amygdala enlargement on the pre-operative brain MRI in patients with TLE does not affect the surgical outcome following ATL-AH, and it does not necessarily suggest abnormal histopathology. These findings suggest that amygdala enlargement might reflect a secondary reactive process to seizures in the epileptogenic temporal lobe.
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Affiliation(s)
- Lubna Shakhatreh
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ben Sinclair
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Australia
| | - Catriona McLean
- Department of Anatomical Pathology, The Alfred Hospital, Melbourne, Australia
| | - Elaine Lui
- Department of Radiology, University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew P Morokoff
- Department of Surgery, University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
| | - James A King
- Department of Surgery, University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
| | - Zhibin Chen
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
- Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Australia
- Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Terence J O'Brien
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
| | - Patrick Kwan
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Neurology, Alfred Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia
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Abstract
Background: An aura is usually considered to be the initial clinical sign of a seizure. The types of abnormal neuron activities (i.e., localized and generalized firing) play an important role in the diagnosis of epilepsy. The goal of this study was to investigate the types of auras and its correlation with the localization and treatment of epilepsy. Methods: The 426 epileptic patients with auras from a single center were reviewed with reference to International League Against Epilepsy (ILAE, 1981) classification; the clinical manifestations and incidence of auras were analyzed in this retrospective study, as well as the results of electroencephalogram (EEG), brain magnetic resonance imaging (MRI) and the treatment methods. Results: Among the 426 epileptic patients, six different types of auras were defined, including autonomic auras, sensory auras, mental and affective auras, aura as vertigo, cognitive auras, and unspeakable feelings. Duration of auras ranged from 2 s to 7 min; the median duration of auras was 64.2 s. Abnormal EEG was observed in 297 (69.72%) patients. Moreover, abnormal brain MRI was observed in 125 (29.34%) patients. Nineteen (4.46%) epilepsy patients with auras underwent both surgeries and antiepileptic drugs (AEDs) while others were treated only with AEDs. Conclusions: This study suggested that auras played an important role in the diagnosis, classification, and localization of epilepsy. Epileptic aura could help differentiate partial seizure from generalized seizure.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
| | - Xiao-Ming Guo
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
| | - Xun Wu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
| | - Ping Li
- Department of Neurology, University at Buffalo, Buffalo, New York 14203, USA
| | - Wei-Wei Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China, India
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Mao YT, Goh E, Churilov L, McIntosh A, Ren YF, O'Brien TJ, Davis S, Dong Q, Yan B, Kwan P. White Matter Hyperintensities on Brain Magnetic Resonance Imaging in People with Epilepsy: A Hospital-Based Study. CNS Neurosci Ther 2016; 22:758-63. [PMID: 27265831 DOI: 10.1111/cns.12571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/01/2022] Open
Abstract
AIMS We aim to explore whether people with epilepsy have increased white matter hyperintensities (WMHs). METHODS Eligible patients were categorized into newly diagnosed epilepsy (NE) and chronic epilepsy (CE); the latter were subdivided to those treated with enzyme-inducing antiepileptic drugs (EIAEDs) with or without non-enzyme-inducing antiepileptic drugs (NEIAEDs) and those with NEIAEDs only. WMHs were measured using age-related white matter changes (ARWMC) scale and compared between patients and healthy control group. Higher scores indicate greater WMH changes. The strengths of associations were estimated as incidence rate ratios (IRRs) with 95% confidence interval (CI). RESULTS A total of 217 patients were included in the analysis, of whom 67 had NE, 45 had CE treated with NEIAEDs, and 105 had CE treated with EIAEDs. Age was positively associated with ARWMC score (IRR per year, 1.03; 95%CI, 1.03-1.04, P < 0.001). Compared with the healthy control group (n = 23), all patient groups had higher ARWMC score (P < 0.05). The difference was greatest in patients receiving EIAEDs (IRR, 2.13; 95%CI, 1.22-3.70, P = 0.007). CONCLUSIONS WMHs tended to be observed in people with epilepsy, especially in those treated with EIAEDs. People with epilepsy with white matter changes should be evaluated for stroke risk, particularly if they are receiving EIAEDs.
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Affiliation(s)
- Yi-Ting Mao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Enid Goh
- Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience and Mental Health, Melbourne, Vic, Australia.,School of Mathematical and Geospatial Sciences, RMIT University, Melbourne, Vic, Australia
| | - Anne McIntosh
- Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia.,The Epilepsy Research Centre, Austin Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yi-Fan Ren
- Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Terence J O'Brien
- Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Stephen Davis
- Departments of Medicine and Neurology, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia.,Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Patrick Kwan
- Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
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