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NEUROLOGY 2006;66:81-87
© 2006 American Academy of Neurology

Amygdala fMRI lateralizes temporal lobe epilepsy

M. Schacher, PhD, B. Haemmerle, MSc, F. G. Woermann, MD, M. Okujava, MD, D. Huber, MD, T. Grunwald, MD, PhD, G. Krämer, MD and H. Jokeit, PhD

From the Swiss Epilepsy Center (M.S., B.H., T.G., G.K., H.J.) and Institute for Radiology (D.H.), Hirslanden Hospital, Zurich, and Bethel Epilepsy Center (F.G.W.), Mara Hospital, Bielefeld, Switzerland; and Diagnostic Center (M.O.), State Medical Academy, Tbilisi, Georgia.

Address correspondence and reprint requests to Dr. H. Jokeit, Swiss Epilepsy Center, Bleulerstrasse 60, 8008 Zurich, Switzerland; e-mail: h.jokeit{at}swissepi.ch

Objective: To characterize the clinical value of an fMRI task activating the amygdala in controls and patients with mesial temporal lobe epilepsy (MTLE).

Methods: A fearful face fMRI paradigm using video sequences was developed and investigated in 17 patients with epilepsy (12 had MTLE [6 right- and 6 left-sided]) and 17 healthy control subjects. Reproducibility was demonstrated by reimaging 12 of the control subjects. In addition, parahippocampal activation was measured using Roland’s Hometown Walking Task within the same session in all patients and in nine of the control subjects.

Results: A fearful face paradigm led to significant amygdala activation (p < 0.001) in all subjects. Amygdala activation was bilateral in control subjects and clearly lateralized in patients with MTLE. Dissociated amygdala and parahippocampal activation was found in three MTLE patients. A combination of results from both fMRI paradigms improved the lateralization of the side of seizure onset in patients with MTLE.

Conclusions: fMRI activation of the amygdala evoked by an animated fearful face paradigm is strong, reproducible, and specific in individual subjects. The combination of the fearful face paradigm and Roland’s Hometown Walking Task provides a more reliable presurgical mapping of mesial temporal lobe structures.

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 January 10 issue to find the title link for this article.

Supported by Novartis Switzerland AG (M.S.).

Disclosure: The authors report no conflicts of interest.

Received March 21, 2005. Accepted in final form October 3, 2005.






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