title: Relationship between environmental factors and gray matter atrophy in refractory MTLE.
abstract: OBJECTIVE
  To investigate clinical, neuropsychological, and MRI abnormalities (gray matter atrophy [GMA] and white matter atrophy [WMA]) in surgical mesial temporal lobe epilepsy (MTLE) patients with and without familial antecedent for epilepsy.
  
  
  METHODS
  A cohort study including 69 operated patients with unilateral MTLE, divided into a group of 29 patients (mean age 35.8 +/- 10.4 years) with a negative family history (FH) of epilepsy and a group of 40 patients (32.8 +/- 10 years) with a positive FH. We performed voxel-based morphometry (VBM) on preoperative MRIs and investigated possible clinical and neuropsychological differences between the 2 groups. We also performed VBM and t tests to compare the patients' groups with normal controls.
  
  
  RESULTS
  The negative-FH group had lower IQ scores (p = 0.004), performed poorer on the Boston Naming Test (p = 0.02) and on delayed recall (p = 0.03), and presented a more prominent asymmetry index of hippocampal volume (p = 0.04) and more frequent initial precipitating injuries (p = 0.023). VBM showed a more restricted pattern of GMA in the positive-FH group and a more bilateral and widespread pattern of GMA in the negative-FH group, involving thalami, temporal, frontal, parietal, and occipital lobes. WMA was widespread and bilateral in both groups.
  
  
  CONCLUSIONS
  The more widespread structural voxel-based morphometry abnormalities and worse IQ performance identified in the negative-family history (FH) group may result from a stronger environmental influence, including initial precipitating injuries. This is further support for the hypothesis that hippocampal sclerosis in mesial temporal lobe epilepsy with positive FH is determined by a stronger genetic predisposition with less influence of environmental factors compared with patients in the negative-FH group.
authors.affiliation: Department of Neurology, University of Campinas, Cidade Universitaria, Campinas, SP, Brazil 13083-970.
authors.forename: C L
authors.initials: CL
authors.lastname: Yasuda
authors.forename: M E
authors.initials: ME
authors.lastname: Morita
authors.forename: A
authors.initials: A
authors.lastname: Alessio
authors.forename: A R
authors.initials: AR
authors.lastname: Pereira
authors.forename: M L F
authors.initials: ML
authors.lastname: Balthazar
authors.forename: A V
authors.initials: AV
authors.lastname: Saúde
authors.forename: A L F
authors.initials: AL
authors.lastname: Costa
authors.forename: A L C
authors.initials: AL
authors.lastname: Costa
authors.forename: T A
authors.initials: TA
authors.lastname: Cardoso
authors.forename: L E
authors.initials: LE
authors.lastname: Betting
authors.forename: C A M
authors.initials: CA
authors.lastname: Guerreiro
authors.forename: B P
authors.initials: BP
authors.lastname: Damasceno
authors.forename: I
authors.initials: I
authors.lastname: Lopes-Cendes
authors.forename: H
authors.initials: H
authors.lastname: Tedeschi
authors.forename: E
authors.initials: E
authors.lastname: de Oliveira
authors.forename: F
authors.initials: F
authors.lastname: Cendes
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D004777:Environment; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005190:Family; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007361:Intelligence Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D009929:Organ Size