Guerreiro C, Cendes F, Li L M, Jones-Gotman M, Andermann F, Dubeau F, Piazzini A, Feindel W
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
Epilepsia. 1999 Apr;40(4):453-61. doi: 10.1111/j.1528-1157.1999.tb00740.x.
MRI volumetric measurements (MRIvol) have been proven reliable in determining mesial temporal atrophy in patients with TLE. We attempted to correlate the clinical features with different patterns of hippocampal formation (HF) and amygdala (AM) atrophy in patients with TLE without foreign tissue lesion.
We studied 65 patients with refractory TLE. They were divided into five groups according to MRIvol results: pure AM atrophy (n = 11, 10 unilateral and one bilateral), unilateral HF atrophy (n = 16), bilateral HF atrophy (n = 12), unilateral AM + HF atrophy (n = 13), and patients with normal volumes of AM and HF (n = 13). MRIvol of AM and HF were performed by using a protocol previously described by Watson et al. (Neurology 1992;42:1743-50).
Patients with AM atrophy had later onset of seizures compared with those with unilateral HF atrophy (p < 0.01). History of febrile convulsions (p < 0.0001) and frequent secondarily generalized tonic-clonic seizures (GTCSs) were more often found in patients with HF atrophy compared with those with pure AM atrophy and those with normal volumes (p = 0.04). Prolonged postictal confusion was more often found with AM atrophy (p = 0.05). Memory impairment was more severe in patients with HF atrophy than in those with AM atrophy only or in those with normal volumes (p = 0.03). There were no significant differences among the five groups in the following parameters: age, duration of epilepsy, seizure frequency, and presence and type of aura.
Prolonged postictal confusion appeared to be related to AM atrophy, in keeping with previous clinical observations. These patients also had a lower incidence of early febrile convulsions, older age at epilepsy onset, lower frequency of secondary GTCS, and lesser memory dysfunction compared with patients with hippocampal atrophy.
磁共振成像体积测量（MRIvol）已被证明在确定颞叶癫痫（TLE）患者的内侧颞叶萎缩方面是可靠的。我们试图将临床特征与无异物组织病变的TLE患者海马结构（HF）和杏仁核（AM）不同模式的萎缩相关联。
我们研究了65例难治性TLE患者。根据MRIvol结果将他们分为五组：单纯AM萎缩（n = 11，10例单侧和1例双侧）、单侧HF萎缩（n = 16）、双侧HF萎缩（n = 12）、单侧AM + HF萎缩（n = 13）以及AM和HF体积正常的患者（n = 13）。AM和HF的MRIvol采用Watson等人先前描述的方案进行（《神经病学》1992年；42：1743 - 50）。
与单侧HF萎缩患者相比，AM萎缩患者癫痫发作的起始时间较晚（p < 0.01）。与单纯AM萎缩和体积正常的患者相比，HF萎缩患者中热性惊厥病史（p < 0.0001）和频繁的继发性全面强直 - 阵挛发作（GTCSs）更为常见（p = 0.04）。AM萎缩患者更常出现发作后长时间意识模糊（p = 0.05）。HF萎缩患者的记忆障碍比仅AM萎缩或体积正常的患者更严重（p = 0.03）。五组在以下参数方面无显著差异：年龄、癫痫病程、发作频率以及先兆的存在和类型。
发作后长时间意识模糊似乎与AM萎缩有关，这与先前的临床观察结果一致。与海马萎缩患者相比，这些患者早期热性惊厥的发生率较低、癫痫发作起始年龄较大、继发性GTCS频率较低且记忆功能障碍较轻。
