The findings suggest that non-invasive brain stimulation over the TC modulates the ANS activity and the sensory perception of effort and exercise performance, indicating that the brain plays a crucial role in the exercise performance regulation.

The progression of white and gray matter atrophy in patients with mesial temporal lobe epilepsy (MTLE) was more intense in patients with left MTLE and was associated with poorer seizure control and a longer duration of epilepsy.

Whether temporal lobe epilepsy is the result of an isolated, early injury or whether there is ongoing neuronal dysfunction or loss due to seizures is often debated. We attempt to address this issue by using magnetic resonance techniques. Proton magnetic resonance spectroscopic imaging can detect and quantify focal neuronal dysfunction or loss based on reduced signals from the neuronal marker N‐acetylaspartate (NAA), and magnetic resonance imaging (MRI)‐based measurements of hippocampal volumes (MRIvol) can quantify the amount of atrophy in this structure. We performed magnetic resonance spectroscopic imaging and MRIvol in 82 consecutive patients with medically intractable temporal lobe epilepsy to determine whether there was a correlation between seizure frequency, or type or duration of epilepsy, with NAA to creatine (Cr) values or hippocampal volumes. Volumes and spectroscopic resonance intensities were categorized as to whether they were measured from the temporal lobe ipsilateral or contralateral to the predominant electroencephalographic focus. Ipsilateral and contralateral NAA/Cr was negatively correlated with duration of epilepsy. Hippocampal volumes were negatively correlated with duration ipsilaterally but not contralaterally. Frequency of complex partial seizures was not correlated with any of the magnetic resonance measures. However, patients with frequent generalized tonic–clonic seizures had lower NAA/Cr bilaterally and smaller hippocampal volumes ipsilaterally than patients with none or rare generalized tonic–clonic seizures. The results suggest that although an early, fixed injury may cause asymmetric temporal lobe damage, generalized seizures may also cause progressive neuronal dysfunction or loss. Ann Neurol 1999;45:568–576

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Background: Conventional volumetric studies have shown that brain structures functionally and anatomically related to the hippocampus are smaller in patients with drug-refractory medial temporal lobe epilepsy (MTLE). Objectives: To determine the extent of gray matter atrophy in the brains of patients with MTLE and to examine the pattern of atrophy. Design: We performed a voxel-based morphometric study of 43 consecutive patients with unilateral drugrefractory MTLE (21 patients with right-sided MTLE and 22 patients with left-sided MTLE) whose magnetic resonance images showed signs of unilateral hippocampal atrophy. The data from the patients with MTLE were compared with the data from 49 healthy control subjects to identify differences between groups in gray matter concentration (GMC).

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Background: Structural neuroimaging studies have consistently shown a pattern of extra-hippocampal atrophy in patients with left and right drug-refractory medial temporal lobe epilepsy (MTLE). However, it is not yet completely understood how extra-hippocampal atrophy is related to hippocampal atrophy. Moreover, patients with left MTLE often exhibit more intense cognitive impairment, and subtle brain asymmetries have been reported in patients with left MTLE versus right MTLE but have not been explored in a controlled study. Objectives: To investigate the association between extra-hippocampal and hippocampal atrophy in patients with MTLE, and the effect of side of hippocampal atrophy on extra-hippocampal atrophy. Methods: Voxel-based morphometry analyses of magnetic resonance images of the brain were performed to determine the correlation between regional extra-hippocampal grey matter volume and hippocampal grey matter volume. The results from 36 patients with right and left MTLE were compared, and results from the two groups were compared with those from 49 healthy controls. Results: Compared with controls, patients with MTLE showed a more intense correlation between hippocampal grey matter volume and regional grey matter volume in locations such as the contralateral hippocampus, bilateral parahippocampal gyri and frontal and parietal areas. Compared with right MTLE, patients with left MTLE exhibited a wider area of atrophy related to hippocampal grey matter loss, encompassing both the contralateral and ipsilateral hemispheres, particularly affecting the contralateral hippocampus. Conclusions: Our results suggest that left hippocampal atrophy is associated with a larger degree of extrahippocampal atrophy. This may help to explain the more intense cognitive impairment usually observed in these patients.

Objectives: To determine the frequency and progression of hippocampal atrophy in systemic lupus erythematosus (SLE) and the clinical, laboratory and treatment features associated with its occurrence. Methods: 150 patients with SLE and 40 healthy volunteers were enrolled in our study. A complete clinical, laboratory and neurological evaluation was performed. Magnetic resonance imaging was carried out using a 2T scanner (Elscint Prestige) and coronal T1-weighted images were used for manual volumetric measurements. Atrophy was defined as values ,2 standard deviations from the means of controls. Results: At entry into the study, the mean right and left hippocampal volumes of patients were significantly smaller than the hippocampal volumes of controls (p,0.001). After the follow-up magnetic resonance imaging, a significant progression of reduction in right and left hippocampal volumes in patients was observed (p,0.001). At entry, atrophy was identified in 43.9% and at follow-up in 66.7% of patients with SLE. Hippocampal atrophy was related to disease duration (p,0.001) total corticosteroid dose (p = 0.01) and history of central nervous system (CNS) manifestations (p = 0.01). Progression of atrophy was associated with cumulative corticosteroid dose (p = 0.01) and number of CNS events (p = 0.01). Patients with cognitive impairment had more severe hippocampal atrophy than those without. Conclusion: Disease duration, total corticosteroid dose and greater number of CNS manifestations were associated with hippocampal atrophy in patients with SLE. A significant progression of hippocampal atrophy related to total corticosteroid dose and number of CNS events was observed. Further studies are necessary to confirm these findings.