Value of Magnetic Resonance Imaging-Based Measurements of Hippocampal Formations in Patients With Partial Epilepsy

Adam, Claude; Baulac, Michel; Saint‐Hilaire, Jean‐Marc; Landau, Jacqueline; Granat, O; Laplane, D

doi:10.1001/archneur.1994.00540140036012

Cited by 55 publications

(14 citation statements)

References 40 publications

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“…These studies suggest the presence of a more extensive pathology in some patients. Several recent reports in the literature concerned the so-called "dual pathology" (35), in which hippocampal atrophy was documented on MRI in patients with NCTLE (36)(37)(38)(39). Our findings support these assumptions and further define the population at risk of surgical failure as those with ictal EEG rhythms modeled best by lateral or oblique dipole sources.…”

Section: Discussionsupporting

confidence: 84%

Visual and Quantitative Ictal EEG Predictors of Outcome After Temporal Lobectomy

Assaf

Ebersole

1999

Epilepsia

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Summary: Purpose; We investigated whether visual and quantitative ictal EEG analysis could predict surgical outcome after anteromesial temporal lobectomy (AMTL) in which mesial structures, basal, and temporal tip cortex were resected.Methods: We retrospectively reviewed 282 presurgical scalprecorded ictal EEGs (21-to 27-channel) from 75 patients who underwent AMTL. We examined the pattern of seizure onset (frequency, distribution, and evolution) and estimated the principal underlying cerebral generators by using a multiple fixed dipole model that decomposes temporal lobe activity into four sublobar sources (Focus 1.1). We correlated findings with a 2-year postoperative outcome.Results: Sixteen patients had seizures with a well-lateralized, regular 5 to 9-Hz rhythm at onset, that most often had a temporal or subtemporal distribution. All patients became seizure free after surgery. In 5 I patients, seizure onset was remarkable for lateralized slow rhythms (<5 Hz), which sometimes appeared as periodic discharges, were often irregular and stable only for short periods (<5 s), and had a widespread lateral temporal distribution. Among these a favorable surgical outcome was encountered in patients with seizures having prominent anterior-tip sources (16 of 17 seizure free), whereas those with dominant lateral or oblique sources had a less favorable outcome (three of 14 and 13 of 18, respectively). Irregular, nonlateralized slowing characterized seizure onsets in eight patients. Three patients became seizure free after surgery.Conclusions: Both visual and quantitative sublobar source analysis of scalp ictal EEG can predict surgical outcome in most cases after AMTL and complement non-invasive presurgical evaluation.

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Section: Discussionsupporting

confidence: 84%

Visual and Quantitative Ictal EEG Predictors of Outcome After Temporal Lobectomy

Assaf

Ebersole

1999

Epilepsia

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“…By means of in vivo magnetic resonance (MR) imaging, hippocampal volume reduction has been reported in conditions associated with increased corticosteroid levels, 13,14 including Cushing syndrome, 15 posttraumatic stress disorder (PTSD) secondary to childhood sexual abuse 16,17 or combat, 18,19 and depression, 20 although in depression there have been studies with negative findings. 21 Neuronal reduction in hippocampal fields also occurs in postanoxic amnesia, temporal lobe epilepsy, 22,23 Alzheimer disease, 24,25 and schizophrenia. 26 Hippocampal volume reductions on MR imaging have been reported in patients with chronic alcoholism 27 but not in those with alcoholic Korsakoff syndrome.…”

Section: Discussionmentioning

confidence: 99%

Hippocampal Volume in Patients With Alcohol Dependence

Agartz¹,

Momenan²,

Rawlings³

et al. 1999

Arch Gen Psychiatry

324

185

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Background: Smaller hippocampal volumes have been reported in the brains of alcoholic patients than in those of healthy subjects, although it is unclear if the hippocampus is disproportionally smaller than the brain as a whole. There is evidence that alcoholic women are more susceptible than alcoholic men to liver and cardiac damage from alcohol. It is not known whether the hippocampi of the female brain are more vulnerable to alcohol.

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“…Predic-tions regarding localization of the epileptogenic zone, and postoperative outcome with regard to neuropsychological function and seizure control have been based upon this structural data (6)(7)(8). The concordance of MRIdetected structural abnormalities and the ILAE's classification of generalized and partial epilepsy syndromes has not been thoroughly evaluated in the pediatric population.…”

Section: Methodsmentioning

confidence: 99%

Quantitative MRI in Outpatient Childhood Epilepsy

et al. 1997

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Summary:Purpose: In adult studies, MRI volumetrics is a proven technique in presurgical assessment of epilepsy. Hippocampal volume loss is maximal in the syndrome of mesial temporal lobe epilepsy. We aimed (a) to validate this methodology in a pediatric outpatient epilepsy population (b) to determine the relationship of hippocampal asymmetry (HA) to epileptic syndromes and risk factors.Methods: Two neurologists classified the epileptic syndrome in 79 pediatric outpatients, according to the International Classification of Epilepsies and Epileptic Syndromes (ILAE). Hippocampal volumetrics were performed in all patients. HA was defined according to adult control values.Results: Inter-rater variability on measurement of HA was very small (Correlation of test retest of 0.97 on 17 children <3 years old). The rate of HA was 44/79 (57%). In 21 patients, (27%) potentially epileptogenic lesions (other than HA) were identified (cerebral dysgenesis n = 11). HA was present in 9/15 (60%) of temporal lobe epilepsy and in 15/28 (54%) extratemporal onset epilepsy and 5/11 (46%) of generalized symptomatic epilepsy. Analysis confined to <13 years also showed HA was not specific for epileptic syndrome. There was no significant association of febrile convulsions ( I 3%) with HA or temporal lobe epilepsy.Conclusions: There is a high incidence of HA in childhood epilepsy. HA was not confined to clinically defined temporal lobe epilepsy. The poor correlation of epileptic syndrome to quantitative MRI findings may be due to the inadequacies of epilepsy classification in the younger child, with the clinical semiology providing misleading localizing information. Normative childhood data for hippocampal volumes and symmetry is needed. Key Words: MRI-Volumetrics-HippocampusChildhood-Epilepsy .The quantitative MRI detection of hippocampal atrophy and its correlation with pathologically defined hippocampal sclerosis (HS) in adults with mesial temporal lobe epilepsy (1,2) (MTLE) illustrates concordance of an epileptic syndrome with MRI structural abnormalities.between structural abnormality and clinically defined syndromes. METHODSThe prevalence of hippocampal asymmetry (HA) is very low in adults with extratemporal epilepsy (3,4), and in the adult population the specificity of HA for the syndrome of MTLE has been strongly argued (5). Predictions regarding localization of the epileptogenic zone, and postoperative outcome with regard to neuropsychological function and seizure control have been based upon this structural data (6-8). The concordance of MRIdetected structural abnormalities and the ILAE's classification of generalized and partial epilepsy syndromes has not been thoroughly evaluated in the pediatric population. We aimed to quantify hippocampal volumes in a pediatric epilepsy population to examine the relationship Accepted May 20, 1997. Study populationThe study period was June 1995-June 1996. Seventynine children (ages 0-18 years) with a history of a seizure disorder and of having a cerebral MRI at Sydney Children's Hospital were enr...

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Value of Magnetic Resonance Imaging-Based Measurements of Hippocampal Formations in Patients With Partial Epilepsy

Cited by 55 publications

References 40 publications

Visual and Quantitative Ictal EEG Predictors of Outcome After Temporal Lobectomy

Visual and Quantitative Ictal EEG Predictors of Outcome After Temporal Lobectomy

Hippocampal Volume in Patients With Alcohol Dependence

Quantitative MRI in Outpatient Childhood Epilepsy

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