Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neuroimaging Laboratory, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
Epilepsia Open. 2023 Sep;8(3):1111-1122. doi: 10.1002/epi4.12793. Epub 2023 Jul 31.
To investigate how the presence/side of hippocampal sclerosis (HS) are related to the white matter structure of cingulum bundle (CB), arcuate fasciculus (AF), and inferior longitudinal fasciculus (ILF) in mesial temporal lobe epilepsy (MTLE).
We acquired diffusion-weighted magnetic resonance imaging (MRI) from 86 healthy and 71 individuals with MTLE (22 righ-HS; right-HS, 34 left-HS; left-HS, and 15 nonlesional MTLE). We utilized two-tensor tractography and fiber clustering to compare fractional anisotropy (FA) of each side/tract between groups. Additionally, we examined the association between FA and nonverbal (WMS-R) and verbal (WMS-R, RAVLT codification) memory performance for MTLE individuals.
White matter abnormalities depended on the side and presence of HS. The left-HS demonstrated widespread abnormalities for all tracts, the right-HS showed lower FA for ipsilateral tracts and the nonlesional MTLE group did not differ from healthy individuals. Results indicate no differences in verbal/nonverbal memory performance between the groups, but trend-level associations between higher FA of visual memory and the left CB (r = 0.286, P = 0.018), verbal memory (RAVLT) and -left CB (r = 0.335, P = 0.005), -right CB (r = 0.286, P = 0.016), and -left AF (r = 0.287, P = 0.017).
Our results highlight that the presence and side of HS are crucial to understand the pathophysiology of MTLE. Specifically, left-sided HS seems to be related to widespread bilateral white matter abnormalities. Future longitudinal studies should focus on developing diagnostic and treatment strategies dependent on HS's presence/side.
研究海马硬化（HS）的存在/侧别与内侧颞叶癫痫（MTLE）扣带束（CB）、弓状束（AF）和下纵束（ILF）白质结构的关系。
我们从 86 名健康人和 71 名 MTLE 患者（22 例右侧 HS；右侧 HS，34 例左侧 HS；左侧 HS，15 例非病变 MTLE）中获得了弥散加权磁共振成像（MRI）。我们利用双张量束追踪和纤维聚类来比较组间各侧/束的各向异性分数（FA）。此外，我们还检查了 FA 与 MTLE 患者非言语（WMS-R）和言语（WMS-R、RAVLT 编码）记忆表现之间的关系。
白质异常取决于 HS 的侧别和存在。左侧 HS 显示所有束的广泛异常，右侧 HS 显示同侧束的 FA 较低，而非病变 MTLE 组与健康对照组无差异。结果表明，各组之间的言语/非言语记忆表现无差异，但视觉记忆和左侧 CB（r=0.286，P=0.018）、言语记忆（RAVLT）和左侧 CB（r=0.335，P=0.005）、右侧 CB（r=0.286，P=0.016）和左侧 AF（r=0.287，P=0.017）之间存在趋势性关联，与 FA 呈正相关。
我们的研究结果强调了 HS 的存在和侧别对理解 MTLE 病理生理学的重要性。具体来说，左侧 HS 似乎与广泛的双侧白质异常有关。未来的纵向研究应侧重于制定基于 HS 存在/侧别的诊断和治疗策略。
