Bernasconi N, Bernasconi A, Caramanos Z, Andermann F, Dubeau F, Arnold D L
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
Ann N Y Acad Sci. 2000 Jun;911:495-500. doi: 10.1111/j.1749-6632.2000.tb06752.x.
Despite neuropathological and electrophysiological evidence for the involvement of parahippocampal structures in temporal lobe epilepsy (TLE), little attention has been paid to morphometric changes in these structures, and the relation of these changes to TLE. We performed high-resolution MRI volumetric analysis to examine in vivo the morphology of the parahippocampal region in 20 healthy subjects and 6 TLE patients with MRI evidence of unilateral hippocampal atrophy. In normal controls the standardized volume of the left entorhinal cortex (EC) was 1305 +/- 138 mm3 and that of the right EC was 1376 +/- 170 mm3; the left perirhinal cortex (PC) was 2900 +/- 554 mm3 and the right PC was 2771 +/- 486 mm3; the left posterior parahippocampal cortex (PPC) was 2499 +/- 583 mm3 and the right PPC was 2234 +/- 404 mm3. Using a 2 standard deviation cutoff from the mean of normal controls, we found ipsilateral to the seizure focus: (i) a reduction in the volume of the EC in all patients; (ii) a reduction of the PC in 2/6 (33%) patients; (iii) no reduction in the volume of the PPC in any patient. In 3/6 (50%) of patients, the EC was also abnormally small contralateral to the seizure focus. In patients with unilateral TLE, the EC is the most affected structure within the parahippocampal region. Whether this is due to a primary role of the EC in the genesis of TLE or is the consequence of its pivotal position in the reciprocal flow of information between the hippocampus and the neo- and limbic cortices remains to be explored.
尽管有神经病理学和电生理学证据表明海马旁结构参与颞叶癫痫（TLE），但这些结构的形态计量学变化以及这些变化与TLE的关系却很少受到关注。我们进行了高分辨率MRI体积分析，以在体检查20名健康受试者和6名有MRI证据显示单侧海马萎缩的TLE患者海马旁区域的形态。在正常对照中，左侧内嗅皮质（EC）的标准化体积为1305±138mm³，右侧EC为1376±170mm³；左侧嗅周皮质（PC）为2900±554mm³，右侧PC为2771±486mm³；左侧海马旁后皮质（PPC）为2499±583mm³，右侧PPC为2234±404mm³。使用正常对照平均值的2个标准差截断值，我们发现癫痫灶同侧：（i）所有患者的EC体积减小；（ii）2/6（33%）的患者PC体积减小；（iii）所有患者的PPC体积均未减小。在3/6（50%）的患者中，癫痫灶对侧的EC也异常小。在单侧TLE患者中，EC是海马旁区域内受影响最严重的结构。这是由于EC在TLE发生中起主要作用，还是其在海马与新皮质和边缘皮质之间信息交互的关键位置所导致的结果，仍有待探索。
