Pejovic Aleksa, Jokovic Zorica, Koepp Matthias, Dakovic Marko, Bascarevic Vladimir, Jovanovic Marija, Vojvodic Nikola, Sokic Dragoslav, Ristic Aleksandar J
Clinic for Neurology, University Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Epilepsia Open. 2024 Dec;9(6):2479-2486. doi: 10.1002/epi4.13088. Epub 2024 Oct 28.
Cortical atrophy close to medial temporal structures has been described consistently in patients with temporal lobe epilepsy (TLE). Successful TLE surgery may have a neuroprotective effect preventing further atrophy of temporal and extratemporal cortex. However, the effects of epilepsy surgery on subcortical structures demand additional enlightenment. This work aimed to determine how epilepsy surgery affects volumes of subcortical structures in medically refractory temporal lobe epilepsy patients.
We compared MRI volumes of subcortical structures in 62 patients with TLE (36 left, 26 right) before and after anterior temporal lobectomy with 38 TLE patients (20 left, 18 right) who were considered to be good surgical candidates and had at least two brain MRIs.
There were no volume differences in subcortical structures on preoperative and initial MRIs of non-operated TLE patients. At baseline, the ipsilateral thalamus and putamen in TLE patients were marginally smaller than contralateral structures. Operated patients showed a significant postoperative volume reduction in ipsilateral thalamus, putamen, and globus pallidus. In contrast, there were no significant volumetric reductions in non-operated patients longitudinally. There were no volumetric changes associated with different surgical outcomes or different postoperative cognitive outcomes.
Our study demonstrated postoperative volume loss of thalamus, putamen and globus pallidus ipsilaterally to the side of resection. Our findings suggest surgery-related changes, likely Wallerian degeneration within subcortical networks not related to seizure or cognitive outcome.
We studied 100 patients with epilepsy, comparing those who had surgery to those who did not. After surgery, the thalamus, putamen and globus pallidus on the same side as the surgery shrank significantly, but not in non-surgery patients. This suggests surgery-related changes in deeper brain structures, unrelated to seizure freedom or cognitive outcomes. This research sheds additional light on the response of the subcortical structure to epilepsy surgery, highlighting potential areas for further study.
颞叶癫痫（TLE）患者中，内侧颞叶结构附近的皮质萎缩一直有相关描述。成功的TLE手术可能具有神经保护作用，可防止颞叶和颞外皮质进一步萎缩。然而，癫痫手术对皮质下结构的影响还需要更多的研究。本研究旨在确定癫痫手术如何影响药物难治性颞叶癫痫患者皮质下结构的体积。
我们比较了62例TLE患者（36例左侧，26例右侧）在进行前颞叶切除术前和术后的皮质下结构MRI体积，以及38例被认为是良好手术候选者且至少有两次脑部MRI检查的TLE患者（20例左侧，18例右侧）。
未手术的TLE患者术前和首次MRI检查时皮质下结构的体积没有差异。在基线时，TLE患者同侧丘脑和壳核略小于对侧结构。手术患者术后同侧丘脑、壳核和苍白球体积显著减小。相比之下，未手术患者纵向体积没有显著减小。体积变化与不同的手术结果或术后认知结果无关。
我们的研究表明，切除侧同侧丘脑、壳核和苍白球术后体积减小。我们的研究结果表明手术相关的变化，可能是皮质下网络内的华勒氏变性，与癫痫发作或认知结果无关。
我们研究了100例癫痫患者，比较了手术患者和未手术患者。手术后，手术侧的丘脑、壳核和苍白球明显缩小，但未手术患者没有。这表明深部脑结构存在与手术相关的变化，与癫痫发作缓解或认知结果无关。这项研究进一步揭示了皮质下结构对癫痫手术的反应，突出了潜在的进一步研究领域。
