HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 72, Number 20, May 19, 2009 Data Supplement Korean Translation Italian Translation All Versions of this Article: 01.wnl.0000345969.57574.f5v1 72/20/1747    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Bernhardt, B. C. Articles by Bernasconi, N. PubMed PubMed Citation Articles by Bernhardt, B. C. Articles by Bernasconi, N. Related Collections MRI All Epilepsy/Seizures Epilepsy surgery Related Article

Longitudinal and cross-sectional analysis of atrophy in pharmacoresistant temporal lobe epilepsy

From the Departments of Neurology (B.C.B., H.K., A.C.E., A.B., N.B.) and Mathematics and Statistics (K.J.W.), Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Neda Bernasconi, Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, Canada H3A 2B4 neda{at}bic.mni.mcgill.ca

Background: Whether recurrent epileptic seizures induce brain damage is debated. Disease progression in epilepsy has been evaluated only in a few community-based studies involving patients with seizures well controlled by medication. These studies concluded that epilepsy does not inevitably lead to global cerebral damage.

Objective: To track the progression of neocortical atrophy in pharmacoresistant temporal lobe epilepsy (TLE) using longitudinal and cross-sectional designs.

Methods: Using a fully automated measure of cortical thickness on MRI, we studied a homogeneous sample of patients with pharmacoresistant TLE. In the longitudinal analysis (n = 18), fixed-effect models were used to quantify cortical atrophy over a mean interscan interval of 2.5 years (range = 7 to 90 months). In the cross-sectional analysis (n = 121), we correlated epilepsy duration and thickness. To dissociate normal aging from pathologic progression, we compared aging effects in TLE to healthy controls.

Results: The longitudinal analysis mapped progression in ipsilateral temporopolar and central and contralateral orbitofrontal, insular, and angular regions. In patients with more than 14 years of disease, atrophy progressed more rapidly in frontocentral and parietal regions that in those with shorter duration. The cross-sectional study showed progressive atrophy in the mesial and superolateral frontal, and parietal cortices.

Conclusions: Our combined cross-sectional and longitudinal analysis in patients with pharmacoresistant temporal lobe epilepsy demonstrated progressive neocortical atrophy over a mean interval of 2.5 years that is distinct from normal aging, likely representing seizure-induced damage. The cumulative character of atrophy underlies the importance of early surgical treatment in this group of patients.

Abbreviations: GM = gray matter; TLE = temporal lobe epilepsy; WM = white matter.

Supplemental data at www.neurology.org

Editorial, page 1718

e-Pub ahead of print on February 25, 2009, at www.neurology.org.

Supported by a grant from the Canadian Institutes of Health Research (CIHR). B.B. was supported by the German National Merit Foundation and the German Academic Exchange Service.

Disclosure: The authors report no disclosures.

Received August 20, 2008. Accepted in final form December 15, 2008.

Related Article

Temporal lobe epilepsy is a progressive neurologic disorder: Time means neurons!

Gregory D. Cascino
Neurology 2009 72: 1718-1719. [Full Text] [PDF]

This article has been cited by other articles:

				M. Madden and T. Sutula Beyond hippocampal sclerosis: The rewired hippocampus in temporal lobe epilepsy Neurology, September 29, 2009; 73(13): 1008 - 1009. [Full Text] [PDF]

				G. D. Cascino Temporal lobe epilepsy is a progressive neurologic disorder: Time means neurons! Neurology, May 19, 2009; 72(20): 1718 - 1719. [Full Text] [PDF]