Morphometric MRI features are associated with surgical outcome in mesial temporal lobe epilepsy with hippocampal sclerosis

Morphometric MRI features are associated with surgical outcome in mesial temporal lobe epilepsy with hippocampal sclerosis

Author Fernandes Castilho Garcia, Maria Teresa Autor UNIFESP Google Scholar
Gaca, Larissa Botelho Autor UNIFESP Google Scholar
Sandim, Gabriel Barbosa Autor UNIFESP Google Scholar
Assuncao Leme, Idaiane Batista Google Scholar
Carrete Junior, Henrique Autor UNIFESP Google Scholar
Centeno, Ricardo Silva Autor UNIFESP Google Scholar
Sato, Joao Ricardo Google Scholar
Targas Yacubian, Elza Marcia Autor UNIFESP Google Scholar
Abstract Purpose: Corticoamygdalohippocampectomy (CAH) improves seizure control, quality of life, and decreases mortality for refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). One-third of patients continue having seizures, and it is pivotal to determine structural abnormalities that might influence the postoperative outcome. Studies indicate that nonhippocampal regions may play a role in the epileptogenic network in MTLE-HS and could generate seizures postoperatively. The aim of this study is to analyze areas of atrophy, not always detected on routine MRI, comparing patients who became seizure free (SF) with those non seizure free (NSF) after CAH, in an attempt to establish possible predictors of surgical outcome. Methods:105 patients with refractory MTLE-HS submitted to CAH (59 left MTLE

46 males) and 47 controls were enrolled. FreeSurfer was performed for cortical thickness and volume estimation comparing patients to controls and SF versus NSF patients. The final sample after post processing procedures resulted in 99 patients. Results: Cortical thickness analyses showed reductions in left insula in NSF patients compared to those SF. Significant volume reductions in SF patients were present in bilateral thalami, hippocampi and pars opercularis, left parahippocampal gyrus and right temporal pole. In NSF patients reductions were present bilaterally in thalami, hippocampi, entorhinal cortices, superior frontal and supramarginal gyri

on the left: superior and middle temporal gyri, temporal pole, parahippocampal gyrus, pars opercularis and middle frontal gyrus

and on the right: precentral, superior, middle and inferior temporal gyri. Comparison between SF and NSF patients showed ipsilateral gray matter reductions in the right entorhinal cortex (p = 0.003) and contralateral parahippocampal gyrus (p = 0.05) in right MTLE-HS. Patients NSF had a longer duration of epilepsy than those SF (p = 0.028). Conclusion: NSF patients exhibited more extensive areas of atrophy than SF ones. As entorhinal cortex and parahippocampal gyrus are reduced in NSF patients compared to those SF these structures might be implicated in the network responsible for the maintenance of postoperative seizures. Duration of epilepsy is a predictor of seizure outcome. (C) 2017 Elsevier B.V. All rights reserved.
Keywords Mesial temporal lobe epilepsy
Hippocampal sclerosis
MRI morphometric analyses
Surgical outcome
xmlui.dri2xhtml.METS-1.0.item-coverage Amsterdam
Language English
Sponsor Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)
Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)
Date 2017
Published in Epilepsy Research. Amsterdam, v. 132, p. 78-83, 2017.
ISSN 0920-1211 (Sherpa/Romeo, impact factor)
Publisher Elsevier Science Bv
Extent 78-83
Access rights Closed access
Type Article
Web of Science ID WOS:000401682300012

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