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From the Brain Research Institute, and Department of Neurology, Austin and Repatriation Medical Center and Department of Medicine, University of Melbourne, Victoria, Australia.
Address correspondence and reprint requests to Dr. Graeme D. Jackson, Brain Research Institute, Neurosciences Building, Repatriation Campus West Heidelberg, 3081, Victoria, Australia; e-mail: g.jackson{at}brain.org.au
BACKGROUND: Repetitive seizures may be associated with progressive neuronal damage measurable by quantitative MRI.
OBJECTIVE: To investigate whether gender is a risk factor for this damage.
METHODS: Sixty patients with refractory temporal lobe epilepsy (TLE) (28 men, 32 women) and 54 healthy controls (28 men, 26 women) were compared by quantitative MRI methods.
RESULTS: Male patients had ipsilateral hemicranial volume loss of 12% (CI 8% to 16%) and contralateral volume loss of 7% (CI:3% to 11%) compared with male controls (p 
0.004, analysis of variance). Female patients were 4% (CI:0.3% to 8%, p = 0.04) smaller than controls in the ipsilateral hemicranium, and not different contralaterally. The patient-to-control difference was greater in men than in women for the ipsilateral (p = 0.003) and contralateral hemicranial volume (p = 0.02). In men, 14% of the ipsilateral (F = 4.7, p = 0.004) and 16% of the contralateral (F = 5.1, p = 0.03) hemicranial volume loss could be attributed to generalized tonic clonic seizures. Compared with controls, patients averaged a 29% smaller ipsilateral and a 5% smaller contralateral hippocampus.
CONCLUSION: Men with TLE have more brain atrophy than women with TLE. Seizure frequency is a factor contributing to reduced brain volumes in men but not in women. Men, therefore, may be more vulnerable to seizure-associated brain abnormalities.–1485
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