Neuroimaging Laboratory, UNICAMP (University of Campinas), Campinas, SP, Brazil.
Neurology. 2010 Nov 9;75(19):1695-701. doi: 10.1212/WNL.0b013e3181fc29dd.
To investigate the relationship between brain MRI and clinical characteristics and patterns of antiepileptic drug (AED) response in patients with mesial temporal lobe epilepsy (MTLE).
A total of 165 MTLE patients were divided into seizure-free with AED (AED responders, n = 50), pharmacoresistant (n = 87), and remitting-relapsing seizure control group (n = 28). All groups were evaluated regarding age, frequency of seizures, and age at epilepsy onset, duration of epilepsy, febrile seizures, presence and side of hippocampal atrophy (HA), and initial precipitating injuries. For gray matter (GM) MRI voxel-based morphometry (VBM) we selected only patients with unilateral HA on visual MRI analysis (n = 100). Comparisons were made between all groups and 75 healthy controls.
Age at epilepsy onset was lower (p = 0.005) and initial frequency of seizures was higher in the pharmacoresistant compared with the other 2 groups (p = 0.018). All groups showed GM atrophy compared to controls in ipsilateral hippocampus, bilateral parahippocampal gyri, frontal, occipital, parietal, and cerebellar areas. In the AED responders group, such findings were more restricted to areas ipsilateral to the epileptic focus and more widespread in the pharmacoresistant and remitting-relapsing groups. VBM pairwise comparisons showed areas with GM volume reduction in the pharmacoresistant and remitting-relapsing groups compared with AED responders in bilateral periorbital frontal (p < 0.01), cingulum (p < 0.05), and temporal lobe contralateral to the epileptic focus (p < 0.05).
Pharmacoresistant and remitting-relapsing groups presented a similar pattern of GM atrophy, which was more widespread compared with AED responders. Conversely, age at epilepsy onset was lower and initial seizure frequency was higher in pharmacoresistant patients.
探讨内侧颞叶癫痫（MTLE）患者脑 MRI 与临床特征及抗癫痫药物（AED）反应模式的关系。
将 165 例 MTLE 患者分为 AED 无发作组（AED 反应者，n=50）、耐药组（n=87）和缓解-复发发作控制组（n=28）。评估所有组的年龄、发作频率、癫痫发病年龄、癫痫持续时间、热性惊厥、海马萎缩（HA）的存在和侧别，以及初始诱发损伤。对于灰质（GM）MRI 基于体素的形态计量学（VBM），我们仅选择视觉 MRI 分析显示单侧 HA 的患者（n=100）。比较所有组与 75 名健康对照者之间的差异。
耐药组的癫痫发病年龄较低（p=0.005），初始发作频率较高（p=0.018）。与对照组相比，所有组在同侧海马、双侧海马旁回、额、顶、枕和小脑区域均出现 GM 萎缩。在 AED 反应者组中，这些发现更局限于癫痫灶同侧的区域，在耐药组和缓解-复发组中更为广泛。VBM 两两比较显示，耐药组和缓解-复发组的 GM 体积较 AED 反应者减少，主要位于双侧眶额部（p<0.01）、扣带回（p<0.05）和与癫痫灶对侧的颞叶（p<0.05）。
耐药组和缓解-复发组的 GM 萎缩模式相似，较 AED 反应者更为广泛。相反，耐药组的癫痫发病年龄较低，初始发作频率较高。
