Mourre Hélène, Makhalova Julia, Soncin Lisa, Garnier Elodie, Dary Hugo, Le Troter Arnaud, Haast Roy A M, Testud Benoit, Arthuis Marie, Villalon Samuel Medina, Lagarde Stanislas, Pizzo Francesca, Bénar Christian, Ranjeva Jean-Philippe, Guye Maxime, Bartolomei Fabrice
APHM, Timone Hospital, Epileptology and Cerebral Rhythmology, Marseille, France.
Aix Marseille Univ, CNRS, CRMBM, Marseille, France.
Ann Clin Transl Neurol. 2025 Jul;12(7):1395-1407. doi: 10.1002/acn3.70071. Epub 2025 May 19.
Amygdala enlargement has been the subject of controversial studies regarding its significance in terms of pathogenicity both in epilepsy and in psychiatric comorbidities such as anxiety, depression, and post-traumatic stress disorder. However, no causal link has been established in either direction, and the role of distinct amygdala nuclei remains unknown. We investigated volumetric changes of the amygdala and its nine main nuclei and their associations with psychiatric comorbidities in patients with drug-resistant focal epilepsy.
Eighty-seven adult patients with drug-resistant focal epilepsy, available 7 T MRI, and completed standardized psychiatric assessments were included. Whole amygdala and nuclei volumes were quantified and compared to healthy controls. Correlations between the amygdala or nuclei volumes and psychiatric scores were analyzed, as well as the prevalence and severity of each comorbidity depending on the presence of enlargement.
Amygdala enlargement was present in 41% of patients, with bilateral enlargement observed in 30% of these cases, while atrophy was noted in 2%. Bilateral enlargement correlated with higher posttraumatic stress disorder and depression scores. Central nucleus enlargement was associated with a greater prevalence of depression and more severe anxiety. Bilateral enlargement of distinct nuclei in the basolateral group was linked to more severe depression or posttraumatic stress disorder.
These findings suggest that bilateral amygdala enlargement, particularly in specific nuclei, may serve as a morphological marker of psychiatric comorbidities in epilepsy. Further research is needed to explore the specific roles of amygdala nuclei in psycho-epileptogenesis.
杏仁核增大一直是关于其在癫痫以及焦虑、抑郁和创伤后应激障碍等精神共病的致病性方面意义的争议性研究主题。然而，尚未在任何一个方向上建立因果联系，并且不同杏仁核核团的作用仍然未知。我们研究了药物难治性局灶性癫痫患者杏仁核及其九个主要核团的体积变化及其与精神共病的关联。
纳入87例患有药物难治性局灶性癫痫、可进行7T磁共振成像（MRI）且完成标准化精神评估的成年患者。对整个杏仁核和核团体积进行量化，并与健康对照进行比较。分析杏仁核或核团体积与精神评分之间的相关性，以及根据增大情况每种共病的患病率和严重程度。
41%的患者存在杏仁核增大，其中30%的病例观察到双侧增大，而2%的病例出现萎缩。双侧增大与较高的创伤后应激障碍和抑郁评分相关。中央核增大与更高的抑郁症患病率和更严重的焦虑相关。基底外侧组不同核团的双侧增大与更严重的抑郁或创伤后应激障碍有关。
这些发现表明，双侧杏仁核增大，特别是在特定核团中，可能作为癫痫中精神共病的形态学标志物。需要进一步研究来探索杏仁核核团在精神癫痫发生中的具体作用。
