title: Patterns of subregional mesiotemporal disease progression in temporal lobe epilepsy.
abstract: OBJECTIVE
  Evidence for disease progression in the mesiotemporal lobe is mainly derived from global volumetry of the hippocampus. In this study, we tracked progressive structural changes in the hippocampus, amygdala, and entorhinal cortex in drug-resistant temporal lobe epilepsy at a subregional level. Furthermore, we evaluated the relation between disease progression and surgical outcome.
  
  
  METHODS
  We combined cross-sectional modeling of disease duration in a large cohort of patients (n = 134) and longitudinal analysis in a subset that delayed surgery (n = 31). To track subregional pathology, we applied surface-shape analysis techniques on manual mesiotemporal labels.
  
  
  RESULTS
  Longitudinal and cross-sectional designs showed consistent patterns of progressive atrophy in hippocampal CA1, anterolateral entorhinal, and the amygdalar laterobasal group bilaterally. These regions also exhibited more marked age-related volume loss in patients compared with controls. We found a faster progression of hippocampal atrophy in patients with a seizure frequency ≥6 per month. High rates of contralateral entorhinal cortex atrophy predicted postsurgical seizure relapse.
  
  
  CONCLUSIONS
  We observed progressive atrophy in hippocampal, amygdalar, and entorhinal subregions that frequently display neuronal loss on histology. The bilateral character of cumulative atrophy highlights the importance of early surgery. In patients who nevertheless delay this procedure, serial scanning may provide markers of surgical outcome.
authors.affiliation: From the Neuroimaging of Epilepsy Laboratory, Department of Neurology and Brain Imaging Center, McGill University, Montreal Neurological Institute and Hospital, Montreal, Canada.
authors.forename: Boris C
authors.initials: BC
authors.lastname: Bernhardt
authors.forename: Hosung
authors.initials: H
authors.lastname: Kim
authors.forename: Neda
authors.initials: N
authors.lastname: Bernasconi
mesh_terms: D000328:Adult; D000368:Aged; D000679:Amygdala / Q000473:pathology*; D001284:Atrophy / Q000473:pathology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D018728:Entorhinal Cortex / Q000473:pathology*; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000601:surgery; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult