Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, Canada H3A 2B4.
Neurology. 2010 Jun 1;74(22):1776-84. doi: 10.1212/WNL.0b013e3181e0f80a.
To assess the reproducibility of neocortical atrophy and its clinical significance across the spectrum of temporal lobe epilepsy (TLE), in particular with respect to postsurgical outcome.
MRI-based cortical thickness measurement was obtained in 105 patients. A total of 58 had hippocampal atrophy on magnetic resonance volumetry (TLE-HA) and 47 had normal hippocampal volumes (TLE-NV). Twenty-seven patients had repeated scans with a mean interval of 28 months. Patients were compared to 48 age- and sex-matched healthy controls. We used linear models to assess cortical thinning and the effect of seizure control after surgery. Reproducibility of finding cortical atrophy was statistically evaluated using bootstrap simulations.
Cross-sectional and longitudinal analyses revealed highly similar topology and rates of neocortical thinning in both TLE groups, predominantly in frontocentral, temporal, and cingulate regions. Bootstrap methods showed that at least 20 subjects per group were necessary to reliably observe these patterns of atrophy in TLE. Moreover, power analysis showed that even with sample sizes of 80 subjects per group, differences in thickness between TLE-HA and TLE-NV would be marginal. With respect to postsurgical outcome, we found an association between residual seizures and atrophy in temporopolar and insular cortices in TLE-HA, and in the posterior quadrant in TLE-NV.
We demonstrated with a high degree of confidence that static and dynamic effects of epilepsy impact similarly the neocortex of patients with hippocampal atrophy and patients with normal hippocampal volumes. On the contrary, areas predicting unfavorable postsurgical outcome were distinct, suggesting different configurations of epileptogenic networks in these 2 groups.
评估颞叶癫痫（TLE）谱系中皮质萎缩的可重复性及其临床意义，特别是与术后结果的关系。
对 105 例患者进行基于 MRI 的皮质厚度测量。共有 58 例患者存在磁共振容积成像上的海马萎缩（TLE-HA），47 例患者海马体积正常（TLE-NV）。27 例患者进行了平均间隔 28 个月的重复扫描。将患者与 48 名年龄和性别匹配的健康对照者进行比较。我们使用线性模型来评估皮质变薄和手术后癫痫控制的效果。使用 bootstrap 模拟对发现皮质萎缩的可重复性进行统计学评估。
横断面和纵向分析显示，两组 TLE 患者的皮质萎缩的拓扑结构和速度高度相似，主要在前额中央、颞叶和扣带回区域。bootstrap 方法表明，每组至少需要 20 名患者才能可靠地观察到 TLE 中的这些萎缩模式。此外，功效分析表明，即使每组有 80 名患者，TLE-HA 和 TLE-NV 之间的厚度差异也微不足道。关于术后结果，我们发现 TLE-HA 中颞极和岛叶皮质以及 TLE-NV 中后象限的残余癫痫与萎缩之间存在关联。
我们以高度的置信度证明，癫痫的静态和动态效应同样影响海马萎缩和海马体积正常的 TLE 患者的皮质。相反，预测术后不良结果的区域是不同的，这表明这两组患者的致痫网络有不同的配置。
