Widespread neocortical abnormalities in temporal lobe epilepsy with and without mesial sclerosis.
OBJECTIVE
Extrafocal structural abnormalities have been consistently described in temporal lobe epilepsy (TLE) with mesial temporal lobe sclerosis (TLE-MTS). In TLE without MTS (TLE-no) extrafocal abnormalities are more subtle and often require region of interest analyses for their detection. Cortical thickness measurements might be better suited to detect such subtle abnormalities than conventional whole brain volumetric techniques which are often negative in TLE-no. The aim of this study was to seek and characterize patterns of cortical thinning in TLE-MTS and TLE-no.


METHODS
T1 weighted whole brain images were acquired on a 4 T magnet in 66 subjects (35 controls, 15 TLE-MTS, 16 TLE-no). Cortical thickness measurements were obtained using the FreeSurfer software routine. Group comparisons and correlation analyses were done using the statistical routine of FreeSurfer (FDR, p=0.05).


RESULTS
TLE-MTS and TLE-no showed both widespread temporal and extratemporal cortical thinning. In TLE-MTS, the inferior medial and posterior temporal regions were most prominently affected while lateral temporal and opercular regions were more affected in TLE-no. The correlation analysis showed a significant correlation between the ipsilateral hippocampal volume and regions of thinning in TLE-MTS and between inferior temporal cortical thickness and thinning in extratemporal cortical regions in TLE-no.


CONCLUSIONS
The pattern of thinning in TLE-no was different from the pattern in TLE-MTS. This finding suggests that different epileptogenic networks could be involved in TLE-MTS and TLE and further supports the hypothesis that TLE-MTS and TLE-no might represent two distinct TLE syndromes.
Mueller
S G
SG
Center for Imaging of Neurodegenerative Diseases and Department of Radiology, University of California, San Francisco, CA 94121, USA. susanne.mueller@ucsf.edu
Laxer
K D
KD
Barakos
J
J
Cheong
I
I
Garcia
P
P
Weiner
M W
MW
D000293:Adolescent; D000328:Adult; D002549:Diffuse Cerebral Sclerosis of Schilder / Q000150:complications* / Q000473:pathology*; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019579:Neocortex / Q000473:pathology*; D013702:Temporal Lobe / Q000473:pathology*; D055815:Young Adult