Clinical features and pathological characteristics of amygdala enlargement in mesial temporal lobe epilepsy.
Although the hippocampus is considered an important site of seizures in mesial temporal lobe epilepsy (mTLE), the amygdala may also have a significant role. Amygdala enlargement is occasionally found in patients with mTLE, and volumetric detection of amygdala enlargement has been documented in "image-negative" patients with TLE. However, only limited data have been reported on the clinical features, surgical outcomes, and pathological characteristics in patients with mTLE with amygdala enlargement. We recruited 12 patients who had undergone surgical treatment for refractory epilepsy with radiological evidence of amygdala enlargement, and 11 became seizure free. All patients showed homogenously increased amygdala volumes on MRI without enhancement and underwent surgical treatment for mTLE. Pathology results revealed that eight patients had focal cortical dysplasia (FCD), two had ganglioglioma, one had oligodendroglioma, and one had astrocytoma. The clinical features and MRI findings were largely indistinguishable between the patients with brain tumors and those with FCD, but the patients with brain tumors tended to be younger at the time of seizure onset. Our study shows that surgical treatment of epilepsy in patients with amygdala enlargement usually has a favorable outcome. FCD was the most frequent pathological diagnosis in these patients. However, a brain tumor should be considered in the differential diagnosis, especially in young patients, because it is often difficult to differentiate FCD from a brain tumor on radiological features.
Department of Neurology, Konkuk University Medical Center, Konkuk University College of Medicine, Seoul, Republic of Korea.
Dong Wook
DW
Kim
Sang Kun
SK
Lee
Chun Kee
CK
Chung
Young-Cho
YC
Koh
Geeyoung
G
Choe
So Dug
SD
Lim
D000293:Adolescent; D000328:Adult; D000679:Amygdala / Q000473:pathology*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000473:pathology; D008875:Middle Aged; D055815:Young Adult