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From the Clinical Epilepsy Section (Drs. Theodore, Bhatia, Hatta, DeCarli, and Bookheimer, and S. Fazilat), Epilepsy Research Branch, NINDS, NIH, Bethesda, MD; and Department of Neurology (Dr. Gaillard), Children’s National Medical Center, Washington, DC.
Address correspondence and reprint requests to Dr. William H. Theodore, NIH 10/5N-250, Bethesda, MD 20892.
BACKGROUND: Previous studies have suggested a variety of factors that may be associated with the presence of hippocampal formation (HF) atrophy in patients with complex partial seizures (CPS), including a history of complex or prolonged febrile seizures (FS), age at seizure onset, and epilepsy duration.
OBJECTIVE: To determine whether epilepsy duration is related to HF atrophy.
METHODS: We performed MRIs on 35 patients with uncontrolled CPS who had temporal lobe ictal onset on video-EEG. None had evidence for an alien tissue lesion or extra-hippocampal seizure onset. All had a history of secondary generalization. Brain structures were drawn on consecutive images and pixel points summed from successive pictures to calculate volumes.
RESULTS: Nine patients with a history of complex or prolonged FS had smaller ipsilateral HF volume and ipsilateral/contralateral ratio than did patients without a history of FS. Epilepsy duration had a significant relation to ipsilateral HF volume and ipsilateral/contralateral ratio. In a multivariate analysis, the effect of duration, but not age at onset or scan, was significant. Patients with a history of FS did not have earlier age at epilepsy onset or longer duration.
CONCLUSIONS: A history of FS predicted the severity of HF atrophy in our patients. Age at onset or study was not a significant factor. Epilepsy duration, however, did have a significant effect, suggesting that, after an initial insult, progressive HF damage may occur in patients with persistent seizures.
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