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Seizure frequency and lateralization affect progression of atrophy in temporal lobe epilepsy

From the Department of Neurology, University of Campinas–UNICAMP, SP, Brazil, ClnAPCe Program, MRC-UNICAMP, SP, Brazil. Dr. Bonilha is currently with the Department of Neuropsychiatry, Arnold School of Public Health, University of South Carolina, Columbia, SC.

Address correspondence and reprint requests to Dr. Fernando Cendes, Department of Neurology, FCM-UNICAMP, Cidade Universitária Zeferino Vaz, Campinas SP, Brazil, CEP 13083-970 fcendes{at}unicamp.br

Background: It is unclear which factors lead to progressive neuronal damage in mesial temporal lobe epilepsy (MTLE). The objective of this study was to evaluate whether progressive hippocampal and extrahippocampal atrophy occur in patients with MTLE and whether this atrophy is related to seizures.

Method: We performed 2 MRI scans in 33 patients with clinical and electroencephalographic diagnosis of MTLE and in 24 healthy controls. MRI was performed in a 2-T scanner, and a T1-weighted gradient-echo sequence with 1 mm thickness was used for voxel-based morphometry analysis. Follow-up images were obtained at least 7 months after the first baseline MRI. Comparisons between the patient’s follow-up and baseline MRIs, and between patients and controls, were performed. A corrected p value of 0.05 was set as the threshold for the statistical analysis.

Results: Follow-up MRI was performed after a median interval of 39 months (range 7–85 months). Three patients were seizure-free between the first and second MRIs. We observed progressive white and gray matter atrophy (p < 0.05) in patients with MTLE. This progression was more intense in patients with left MTLE compared with right MTLE. A higher frequency of seizures and a longer duration of epilepsy were associated with progression of gray and white matter atrophy in patients with MTLE.

Conclusion: The progression of white and gray matter atrophy in patients with mesial temporal lobe epilepsy (MTLE) was more intense in patients with left MTLE and was associated with poorer seizure control and a longer duration of epilepsy.

Abbreviations: ANCOVA = analysis of covariance; DICOM = Digital Imaging and Communications in Medicine; FH = family history; FS = febrile seizure; GTCS = generalized tonic-clonic seizure; HA = hippocampal atrophy; HS = hippocampal sclerosis; IGK = isotropic gaussian kernel; IPI = initial precipitating injury; MNI = Montreal Neurological Institute; MTLE = mesial temporal lobe epilepsy; SE = status epilepticus; TE = echo time; TR = repetition time; VBM = voxel-based morphometry.

Supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil, grants 03/13424-1 and 05/56578-4.

Disclosure: Author disclosures are provided at the end of the article.

Received September 17, 2008. Accepted in final form June 22, 2009.