Matsufuji Mayumi, Utsunomiya Hidetsuna, Inoue Takahito, Yasumoto Sawa, Takashima Sachio, Mitsudome Akihisa
Department of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan.
Pediatr Int. 2012 Feb;54(1):19-26. doi: 10.1111/j.1442-200X.2011.03444.x.
In order to clarify the correlation between morphological characteristics and clinical features in epilepsy patients with unilateral hippocampal abnormality, morphological and morphometric magnetic resonance imaging studies were performed.
We selected a series of childhood-onset epilepsy patients with unilateral hippocampal abnormality. The volume of hippocampal formation and anterior temporal lobe were measured, and the hippocampal morphology was compared with their clinical features. The morphological characteristics of the hippocampal formation were classified into three groups: group I, diffuse and severe volume reduction of the hippocampal formation and anterior temporal lobe with abnormal signal; group II, focal atrophy or focal abnormal signal in the hippocampal formation; and group III, no significant volume reduction but an enlargement of the temporal horn.
All of the patients in group I had a history of status epilepticus in infancy. Temporal lobe epilepsy (TLE) was found in three of four patients. Group II contained TLE in three and frontal lobe epilepsy in one. One patient with intractable TLE had a history of status epilepticus in infancy. Group III contained miscellaneous epilepsies, including benign partial epilepsy with centro-temporal spikes in three of seven patients. Five patients in group III showed some characteristic features of hippocampal malrotation, which refers to incomplete hippocampal infolding.
Diffuse and severe volume reduction of the hippocampal formation and anterior temporal lobe with unilateral hippocampal sclerosis was strongly associated with status epilepticus in infancy. Both hippocampal sclerosis and hippocampal malrotation suggest significant roles in the pathogenesis of epilepsy.
为了阐明单侧海马异常的癫痫患者的形态学特征与临床特征之间的相关性，进行了形态学和形态测量磁共振成像研究。
我们选择了一系列儿童期起病的单侧海马异常的癫痫患者。测量海马结构和颞叶前部的体积，并将海马形态与其临床特征进行比较。海马结构的形态学特征分为三组：I组，海马结构和颞叶前部弥漫性严重体积减小伴信号异常；II组，海马结构局灶性萎缩或局灶性信号异常；III组，体积无明显减小但颞角扩大。
I组所有患者在婴儿期均有癫痫持续状态病史。4例患者中有3例为颞叶癫痫（TLE）。II组中有3例为TLE，1例为额叶癫痫。1例难治性TLE患者在婴儿期有癫痫持续状态病史。III组包括多种癫痫，其中7例患者中有3例为伴有中央颞区棘波的良性部分性癫痫。III组中有5例患者表现出海马旋转不良的一些特征，即海马折叠不完全。
单侧海马硬化伴海马结构和颞叶前部弥漫性严重体积减小与婴儿期癫痫持续状态密切相关。海马硬化和海马旋转不良在癫痫发病机制中均提示有重要作用。
