Institute of Neurology, University Magna Græcia, Catanzaro, Italy.
Epilepsy Behav. 2013 Sep;28(3):489-93. doi: 10.1016/j.yebeh.2013.05.035. Epub 2013 Jul 25.
In patients with mesial temporal lobe epilepsy (MTLE), brain MRI often detects hippocampal sclerosis (HS). Almost half of patients with MTLE do not show any hippocampal damage on visual or volumetric assessment. Here, we wished to prospectively assess 65 patients with MTLE (41 women, mean age: 39±10years, range: 21-69; right (12/65 patients) (MRI-negative) nMTLE; right (14/65 patients) (MRI-positive with HS) pMTLE; left (24/65 patients) nMTLE; and left (15/65 patients) pMTLE) using shape analysis (SA). There were significant differences among pMTLE versus nMTLE for age at seizure onset (20.2±12.8 vs. 31.8±16.7years; p=.0029), duration of epilepsy (14.6±12.7 vs. 21.3±9.6years; p=.0227), risk of refractoriness (p=.0067), frequency of antecedent febrile convulsions (FCs) (p<.001), as well as a history of epilepsy or FCs (p=.0104). All the subjects underwent the same 3-Tesla MRI protocol. Shape analysis of hippocampal formation was conducted comparing each group versus 44 matched controls. In all four subgroups, SA detected a significant atrophy in the corresponding hippocampus that coincided with the epileptogenic area. The damage was significantly more severe in patients with pMTLE (F value: 5.00) than in subgroups with nMTLE (F value: 3.50) and mainly corresponded to the CA1 subregion and subiculum. In the patients with MTLE, SA detects hippocampal damage that lateralizes with the epileptogenic area. Such damage is most prominent in the CA1 subregion and subiculum that are crucial in the pathogenesis of MTLE.
在患有内侧颞叶癫痫（MTLE）的患者中，脑 MRI 通常会检测出海马硬化（HS）。几乎一半的 MTLE 患者在视觉或体积评估上没有任何海马损伤。在这里，我们希望前瞻性评估 65 例 MTLE 患者（41 名女性，平均年龄：39±10 岁，范围：21-69；右侧（12/65 例）（MRI 阴性）nMTLE；右侧（14/65 例）（MRI 阳性伴 HS）pMTLE；左侧（24/65 例）nMTLE；和左侧（15/65 例）pMTLE）使用形状分析（SA）。pMTLE 与 nMTLE 之间在发病年龄（20.2±12.8 与 31.8±16.7 岁；p=.0029）、癫痫持续时间（14.6±12.7 与 21.3±9.6 岁；p=.0227）、难治性风险（p=.0067）、热性惊厥史（FCs）（p<.001）以及癫痫或 FCs 病史（p=.0104）方面存在显著差异。所有患者均接受相同的 3-Tesla MRI 检查方案。比较每组与 44 名匹配对照，进行海马结构的形状分析。在所有四个亚组中，SA 均检测到与致痫区相对应的海马明显萎缩。pMTLE 患者的损伤（F 值：5.00）明显比 nMTLE 亚组（F 值：3.50）严重（F 值：5.00），主要对应 CA1 亚区和下托。在 MTLE 患者中，SA 检测到与致痫区侧化的海马损伤。这种损伤在 CA1 亚区和下托中最为突出，而 CA1 亚区和下托在 MTLE 的发病机制中至关重要。
