Relationship between environmental factors and gray matter atrophy in refractory MTLE.
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.
Yasuda
C L
CL
Department of Neurology, University of Campinas, Cidade Universitaria, Campinas, SP, Brazil 13083-970.
Morita
M E
ME
Alessio
A
A
Pereira
A R
AR
Balthazar
M L F
ML
Saúde
A V
AV
Costa
A L F
AL
Costa
A L C
AL
Cardoso
T A
TA
Betting
L E
LE
Guerreiro
C A M
CA
Damasceno
B P
BP
Lopes-Cendes
I
I
Tedeschi
H
H
de Oliveira
E
E
Cendes
F
F
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