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Basal ganglia involvement in temporal lobe epilepsy

A functional and morphologic study

From Service Hospitalier Frédéric Joliot, I2BM/DSV, CEA, Orsay, France (V.B., F.S., F.C., M.M., R.T., M.-J.R.); Unité de Neurophysiologie et d’Epileptologie, Assistance Publique–Hôpitaux de Paris, Centre Hospitalier Universitaire Bicêtre, Paris, France (V.B.); Service de Neurochirurgie, Hôpital Saint Anne, Paris, France (F.C.); and Service de Neurologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire, Rennes, France (A.B.).

Address correspondence and reprint requests to Dr. Maria-João Ribeiro, Service Hospitalier Frédéric Joliot, I2BM/DSV, CEA, 4, place du Général Leclerc, F-91406 Orsay, France maria-joao.ribeiro{at}cea.fr

Objectives: A decrease of [¹⁸F]fluoro-l-dopa uptake in basal ganglia was recently reported in medically refractory epilepsy. The purpose of this study was to assess the involvement of dopaminergic neurotransmission in refractory temporal lobe epilepsy (TLE) and its relationship to glucose metabolism and morphologic changes.

Methods: Twelve TLE patients were studied using [¹⁸F]fluorodeoxyglucose PET, [¹⁸F]fluoro-l-dopa PET, and MRI and compared with healthy control volunteers. Morphologic cerebral changes were assessed using voxel-based morphometry. Student t test statistical maps of functional and morphologic differences between patients and controls were obtained using a general linear model.

Results: In TLE patients, [¹⁸F]fluoro-l-dopa uptake was reduced to the same extent in caudate and putamen in both cerebral hemispheres as well as in the substantia nigra (SN). These dopaminergic functional alterations occurred without any glucose metabolism changes in these areas. The only mild morphologic abnormality was found in striatal regions without any changes in the SN.

Conclusion: The present study provides support for dopaminergic neurotransmission involvement in temporal lobe epilepsy. The discrepancies between gray matter volume atrophy and the pattern of [¹⁸F]fluoro-l-dopa suggest that basal ganglia involvement is not related to structural subcortical abnormalities. A functional decrease can be ruled out because there was no change of the glycolytic pathway metabolism in these areas.

Abbreviations: AED = antiepileptic drug; BG = basal ganglia; CBZ = carbamazepine; CLB = clobazam; DNET = dysembryoplastic neuroepitheliale tumor; FC = febrile convulsion; [¹⁸F]FDG = [¹⁸F]fluorodeoxyglucose; FWHM = full-width at half-maximum; GBP = gabapentin; GMV = gray matter volume; GVB = vigabatrin; LHS = left hippocampal sclerosis; LTG = lamotrigine; OXC = oxcarbazepine; PB = phenobarbital; ROI = region of interest; SN = substantia nigra; TLE = temporal lobe epilepsy; TPM = topiramate; VPA = sodium valproate; WMV = white matter volume.

Disclosure: The authors report no conflicts of interest.

Received January 25, 2007. Accepted in final form July 23, 2007.

This article has been cited by other articles:

				S. R. Haut and R. L. Albin Dopamine and epilepsy: Hints of complex subcortical roles Neurology, September 9, 2008; 71(11): 784 - 785. [Full Text] [PDF]

				Temporal Lobe Epilepsy and Basal Ganglia Dysfunction Journal Watch Neurology, April 1, 2008; 2008(401): 1 - 1. [Full Text]

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