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Progression in temporal lobe epilepsy

Differential atrophy in mesial temporal structures

From the Department of Neurology and Neurosurgery, McGill University and Montreal Neurological Institute and Hospital, Quebec, Canada.

Address correspondence and reprint requests to Dr. A. Bernasconi, McConnell Brain Imaging Centre, Montreal Neurological Hospital and Institute, 3801 University St., Montreal, Quebec, Canada H3A 2B4; e-mail: andrea{at}bic.mni.mcgill.ca

Objective: To determine the relationship between hippocampal, amygdalar, and entorhinal cortex atrophy and duration of epilepsy, presence of secondary generalized seizures, and prolonged childhood febrile convulsions in patients with pharmacologically intractable temporal lobe epilepsy (TLE).

Methods: Volumetric MRI of the hippocampus, amygdale, and entorhinal cortex were performed in 86 consecutive patients with TLE and 44 age- and sex-matched healthy control subjects. Linear regression analysis was used to explore the relation between the volumetric measurements and the clinical parameters.

Results: In simple regressions, duration of epilepsy but not age at seizure onset was related to hippocampal (r² = 0.19, p < 0.001), entorhinal cortex (r² = 0.11, p = 0.002), and amygdalar (r² = 0.15, p < 0.001) atrophy ipsilateral to the seizure focus. Prediction of the regression function to time of onset of recurrent seizures (time = 0) resulted in a y intercept of <0 for the hippocampus and the entorhinal cortex but was not different from 0 for the amygdala. Patients with a positive history of febrile convulsions had smaller hippocampal volumes ipsilateral to the seizure (p < 0.001). No relationship was found between febrile convulsions and entorhinal cortex and amygdalar volumes or between secondary generalization of seizures and any mesial temporal volume.

Conclusion: Progressive volume loss in the mesial temporal lobe in relation to duration of epilepsy is not limited to the hippocampus but affects the entorhinal cortex and the amygdala.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 26 issue to find the title link for this article.

Received January 25, 2005. Accepted in final form April 14, 2005.

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