Adam C, Baulac M, Saint-Hilaire J M, Landau J, Granat O, Laplane D
Hôpital de la Salpêtrière, Clinique des Maladies du Système Nerveux, Paris, France.
Arch Neurol. 1994 Feb;51(2):130-8. doi: 10.1001/archneur.1994.00540140036012.
To determine the occurrence of magnetic resonance imaging-detected hippocampal atrophy (HA) in patients with partial epilepsy (temporal and extratemporal, cryptogenic, or symptomatic). Magnetic resonance imaging-detected HA has been demonstrated to be both sensitive and specific for hippocampal sclerosis in cryptogenic temporal lobe epilepsy.
Patients' hippocampal formations were measured on a computerized system using T1-weighted, 5-mm contiguous magnetic resonance coronal images made perpendicular to the hippocampus long axis. Hippocampal atrophy was defined on the basis of a normative asymmetry index and correlated with the epileptogenic focus defined by clinical, electroencephalographic, and magnetic resonance imaging (apart from HA) localizing data.
Seventy patients with intractable complex partial seizures of temporal, extratemporal, or undefined origin and 21 healthy control subjects.
Hippocampal atrophy was present in 70% of patients with cryptogenic temporal lobe epilepsy (TLE) (n = 40), 44% of patients with symptomatic TLE (n = 9), 29% of patients with extratemporal epilepsy (n = 14), and 6% of unclassified patients (n = 16). In the cryptogenic TLE category, HA was marked and usually concordant (93%) with electroencephalographic lateralization. Hippocampal atrophy was often mild in the extratemporal epilepsy category. With the use of a wider confidence interval (+/- 3.1 SD instead of +/- 2.2 SD), HA specificity for TLE increased to 93%, HA specificity for lateralizing cryptogenic TLE reached 96%, and HA sensitivity for cryptogenic TLE stood almost unchanged (68%). We found a link between early convulsions and HA occurrence.
Hippocampal atrophy is a marker for TLE. Dual pathologic findings are detected in 44% of symptomatic TLE cases. Mild HA is rarely associated with extratemporal epilepsy. Magnetic resonance imaging-based hippocampal volumetric analysis is a useful method to localize the origin of partial complex seizures.
确定部分性癫痫（颞叶和颞叶外、隐源性或症状性）患者中磁共振成像检测到的海马萎缩（HA）的发生率。磁共振成像检测到的HA已被证明对隐源性颞叶癫痫中的海马硬化既敏感又特异。
使用计算机系统，通过垂直于海马长轴的T1加权、5毫米连续磁共振冠状图像测量患者的海马结构。海马萎缩根据正常不对称指数定义，并与由临床、脑电图和磁共振成像（不包括HA）定位数据确定的致痫灶相关。
70例难治性复杂部分性发作的颞叶、颞叶外或起源不明的患者以及21名健康对照对象。
70%的隐源性颞叶癫痫（TLE）患者（n = 40）、44%的症状性TLE患者（n = 9）、29%的颞叶外癫痫患者（n = 14）和6%的未分类患者（n = 16）存在海马萎缩。在隐源性TLE类别中，HA明显，且通常与脑电图侧别一致（93%）。颞叶外癫痫类别中的海马萎缩通常较轻。使用更宽的置信区间（±3.1标准差而不是±2.2标准差）时，HA对TLE的特异性增加到93%，HA对隐源性TLE侧别的特异性达到96%，HA对隐源性TLE的敏感性几乎不变（68%）。我们发现早期惊厥与HA的发生之间存在关联。
海马萎缩是TLE的一个标志物。44%的症状性TLE病例检测到双重病理结果。轻度HA很少与颞叶外癫痫相关。基于磁共振成像的海马体积分析是定位部分性复杂发作起源的一种有用方法。
