title: Cerebellar volume is linked to cognitive function in temporal lobe epilepsy: a quantitative MRI study.
abstract: BACKGROUND
  Chronic intractable temporal lobe epilepsy (TLE) is associated with certain comorbidities including cognitive impairment. A less common condition among patients with TLE is intermittent explosive disorder (IED), a specific form of aggressive behavior that has been linked to low intelligence and structural pathology in the amygdala. We aimed to identify other neuroanatomical substrates of both cognitive dysfunction and IED in patients with TLE, with special focus on the cerebellum, a brain region known to participate in functional networks involved in neuropsychological and affective processes.
  
  
  METHODS
  Magnetic resonance imaging-based volumetric data from 60 patients with temporal lobe epilepsy (36 with and 24 without IED) were evaluated. Cerebellar, hippocampal, and total brain volumes were processed separately. In a total of 50 patients, the relationship between volumetric measurements and clinical and neuropsychological data (full-scale, verbal, and performance intelligence quotients) was analyzed.
  
  
  RESULTS
  Intermittent explosive disorder in patients with TLE was not significantly linked to any of the regional volumes analyzed. However, cognitive performance showed a significant association both with total brain volume and cerebellar volume measurements, whereby the left cerebellar volume showed the strongest association. A deviation from normal cerebellar volumes was related to lower intelligence. Of note, left cerebellar volume was influenced by age and duration of epilepsy. Hippocampal volumes had a minor influence on cognitive parameters.
  
  
  CONCLUSIONS
  Our findings suggest that cerebellar volume is not linked to IED in patients with TLE but is significantly associated with cognitive dysfunction. Our findings support recent hypotheses proposing that the cerebellum has a relevant functional topography.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany. sabine.hellwig@uniklinik-freiburg.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Hellwig
authors.forename: Vladimir
authors.initials: V
authors.lastname: Gutmann
authors.forename: Michael R
authors.initials: MR
authors.lastname: Trimble
authors.forename: Ludger Tebartz
authors.initials: LT
authors.lastname: van Elst
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression; D000704:Analysis of Variance; D016022:Case-Control Studies; D002531:Cerebellum / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology*; D004833:Epilepsy, Temporal Lobe / Q000150:complications* / Q000523:psychology; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult