Adachi Y, Yagishita A, Arai N
Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, 2-6-1 Musashidai, Fuchu, Tokyo 183-0042, Japan.
Neuroradiology. 2006 Jul;48(7):460-4. doi: 10.1007/s00234-006-0092-1. Epub 2006 Apr 28.
White matter abnormalities in the anterior temporal lobe (WAATL) are sometimes observed on magnetic resonance (MR) images of patients with temporal lobe epilepsy (TLE). Our purpose was to determine whether WAATL could indicate if the seizure foci are ipsilateral on electroencephalograms (EEG) in TLE patients.
We reviewed 112 consecutive patients with medically intractable TLE. We compared the side of seizure foci on EEG (preoperative and intraoperative) and MR images.
Both loss of gray-white matter demarcation and increased signal intensity changes in the anterior white matter (positive WAATL) were observed in 54 of 112 patients (48.2%) with TLE. WAATL were present on the same side as the seizure foci on preoperative intracranial EEG with subdural electrodes (iEEG) and on intraoperative electrocorticography (ECG) in all the patients. In 47 patients, MR images showed WAATL and focal lesions that were possibly epileptogenic for TLE. In 2 of the 47 patients, the seizure foci on iEEG and ECG were contralateral to the focal lesion; in the remaining 45 patients, the seizure foci on surface EEG (sEEG) and ECG and the focal lesion were on the same side. In three patients, no focal lesions were seen but WAATL were present on the same side as the seizure foci on sEEG and ECG. In four patients, MR images showed focal lesions for which epileptogenicity was questionable, and WAATL on the same side as the seizure foci on EEG.
WAATL are clinically useful because they indicate the side of the seizure foci.
在颞叶癫痫（TLE）患者的磁共振（MR）图像上，有时会观察到颞叶前部白质异常（WAATL）。我们的目的是确定WAATL是否能表明TLE患者脑电图（EEG）上的癫痫病灶是否在同侧。
我们回顾了112例连续的药物难治性TLE患者。我们比较了EEG（术前和术中）和MR图像上癫痫病灶的侧别。
112例TLE患者中有54例（48.2%）观察到灰白质分界消失和前部白质信号强度增加（阳性WAATL）。所有患者术前颅内EEG（硬膜下电极iEEG）和术中皮质脑电图（ECG）上的WAATL均与癫痫病灶在同一侧。47例患者的MR图像显示WAATL和可能是TLE致痫灶的局灶性病变。47例患者中有2例，iEEG和ECG上的癫痫病灶与局灶性病变对侧；其余45例患者，表面EEG（sEEG）和ECG上的癫痫病灶与局灶性病变在同一侧。3例患者未见局灶性病变，但sEEG和ECG上的WAATL与癫痫病灶在同一侧。4例患者的MR图像显示致痫性存疑的局灶性病变，EEG上的WAATL与癫痫病灶在同一侧。
WAATL在临床上有用，因为它们能指示癫痫病灶的侧别。
