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From the Departments of Neurology (Drs. Salmenperä and Kälviäinen), Clinical Neurophysiology (M. Könönen), and Radiology (Dr. Vanninen), Kuopio University Hospital; Department of Neurology (Dr. Salmenperä), University of Kuopio; Magnetic Resonance and Image Analysis Research Centre (MARIARC) (Dr. Roberts), University of Liverpool, Pembroke Place, Liverpool, UK; and A.I. Virtanen Institute (Dr. Pitkänen), Kuopio, Finland.
Address correspondence and reprint requests to Dr. Reetta Kälviäinen, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland; e-mail: reetta.kalviainen{at}kuh.fi
Objective: To examine the longitudinal appearance of hippocampal (HC) damage in a prospective follow-up study of patients with newly diagnosed epilepsy.
Methods: A total of 103 patients with newly diagnosed focal epilepsy were scanned with MRI before antiepileptic medication was started. Serial MRI studies were scheduled after 1, 2 to 3, and 5 years of treatment in the ongoing follow-up study. Volumes of the HC were measured from MRI scans according to the Cavalieri method of modern design stereology and compared at different time points together with clinical variables.
Results: No difference was observed in the mean HC volumes between controls and patients at baseline, after 1, 2 to 3, and 5 years of follow-up. Individual analysis showed that 8% of patients had HC damage at the time of the diagnosis and 13% of patients developed HC volume decrease during 2 to 3 years of follow-up. These patients had longer duration of seizure disorder and larger seizure number before the epilepsy was diagnosed and treatment started compared with patients who did not show HC damage.
Conclusions: Hippocampal volume decreases occur in individual patients with newly diagnosed focal epilepsy during the first years of treatment. The data obtained suggest that hippocampal volumetry provides a surrogate marker of the epileptic process.
Received January 14, 2004. Accepted in final form September 8, 2004.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 11 issue to find the title link for this article.
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