Institute of Neurology, University Magna Graecia, Catanzaro, Italy.
Neuroscience Research Center, University Magna Graecia, Catanzaro, Italy.
Epilepsia. 2020 May;61(5):924-934. doi: 10.1111/epi.16503. Epub 2020 Apr 20.
To identify early structural alterations preceding the development of drug-resistance in mild mesial temporal lobe epilepsy (mMTLE), a drug-responsive syndrome ideal for investigating epilepsy pathophysiology and potential prognostic markers of long-term clinical outcome, using magnetic resonance imaging (MRI) at baseline and after 12-year follow-up.
Since 2002, a total of 55 participants with a baseline diagnosis of mMTLE underwent three-dimensional (3D) T1 1.5T MRI. Based on long-term outcome (follow-up 12 ± 3 years), we identified 39 patients with stable mMTLE (smMTLE) and 16 patients who had developed drug-resistance overtime (refractory MTLE [rMTLE]). At follow-up, 21 smMTLE and 13 rMTLE patients underwent 3T-MRI including diffusion-weighted scans. Structural images were processed using longitudinal voxel-based morphometry and standard Freesurfer analysis. Statistical analyses were carried out accounting for age, age at onset, gender, hippocampal volume, and hippocampal sclerosis (Hs).
Patients presented similar demographic, clinical, and Hs features. White matter volume of the arcuate fasciculi, corticospinal tracts, left retrosplenial cingulum, and left inferior longitudinal fasciculus was reduced only in rMTLE patients before the development of drug-resistance. At follow-up, rMTLE showed decreased fractional anisotropy in the corpus callosum, superior longitudinal fasciculi, and major bundles of the right hemisphere.
White matter temporal and extratemporal abnormalities are preexisting in patients with mild MTLE who will develop drug-resistance, independently from the presence of Hs. Thus, these changes might be due to an inherited genetic alteration rather than a subordinate worsening after repeated seizures, multiple antiepileptic drugs, or initial precipitating factors.
通过磁共振成像（MRI）在基线和 12 年后的随访，确定轻度内侧颞叶癫痫（mMTLE）在发展为耐药之前的早期结构改变，mMTLE 是一种对研究癫痫病理生理学和长期临床结局的潜在预后标志物非常理想的药物反应综合征。
自 2002 年以来，共有 55 名基线诊断为 mMTLE 的患者接受了三维（3D）T1 1.5T MRI 检查。根据长期结果（随访 12±3 年），我们确定了 39 名稳定的 mMTLE（smMTLE）患者和 16 名随着时间的推移发展为耐药的患者（难治性 MTLE [rMTLE]）。在随访时，21 名 smMTLE 和 13 名 rMTLE 患者接受了包括弥散加权扫描在内的 3T-MRI 检查。使用纵向体素形态计量学和标准的 Freesurfer 分析处理结构图像。统计分析考虑了年龄、发病年龄、性别、海马体积和海马硬化（Hs）。
患者表现出相似的人口统计学、临床和 Hs 特征。只有在发展为耐药之前，rMTLE 患者的弓状束、皮质脊髓束、左后扣带回和左下纵束的白质体积减少。在随访时，rMTLE 患者的胼胝体、上纵束和右半球主要束的各向异性分数降低。
在将要发展为耐药的轻度 MTLE 患者中，存在颞叶和颞外白质异常，这些异常独立于 Hs 的存在。因此，这些变化可能是由于遗传改变所致，而不是反复癫痫发作、多种抗癫痫药物或初始诱发因素导致的继发性恶化。
