title: Severe hippocampal atrophy is not associated with depression in temporal lobe epilepsy.
abstract: Depression in temporal lobe epilepsy (TLE) is common, is a strong predictor of subjective disability, and may have unique pathophysiological characteristics. Previous studies showed that reduced hippocampal volume is associated with significant depressive symptoms in patients with TLE. We utilized regions of interest analysis of high-resolution brain MRI and a reliable and valid measure of depressive symptoms to evaluate 28 consecutive adult subjects with video-EEG-confirmed TLE. Regions of interest were based on prior human and animal studies of mood and behavioral dysfunction. Forty-three percent of the entire group had significant symptoms of depression, defined by a Beck Depression Inventory (BDI) score of greater than 15. Total hippocampal volumes were significantly smaller in the group with BDI<15, (p<0.007). None of the subjects in the quartile with the smallest left hippocampal volume had a BDI score greater than 15 compared with 57% of the subjects in the upper three quartiles (p<0.008). No other limbic brain structures (amygdala, subcallosal gyrus, subgenual gyrus, gyrus rectus), or total cerebral volume were associated with depressive symptoms. Adequate hippocampal integrity may be necessary to maintain depression symptoms in mesial temporal lobe epilepsy. This finding also supports the possibility of a unique mechanism for depression in mesial temporal lobe epilepsy, such as hyperexcitable neuronal influence on the limbic network.
authors.affiliation: Department of Neurology, University Hospital, Zagreb, Croatia. Electronic address: hrvoje.hecimovic@gmail.com.
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Hecimovic
authors.affiliation: Departamento de Psiquiatría, Universidad Maimónides, Buenos Aires, Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Santos
authors.affiliation: Department of Anatomy and Neurobiology, Washington University, St. Louis, MO, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Price
authors.affiliation: Department of Neurology, Washington University, St. Louis, MO, USA; Department of Psychiatry, Washington University, St. Louis, MO, USA; Department of Radiology, Washington University, St. Louis, MO, USA.
authors.forename: Yvette I
authors.initials: YI
authors.lastname: Sheline
authors.affiliation: Department of Psychiatry, Washington University, St. Louis, MO, USA; Department of Radiology, Washington University, St. Louis, MO, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Mintun
authors.affiliation: Department of Radiology, Washington University, St. Louis, MO, USA.
authors.forename: Abraham Z
authors.initials: AZ
authors.lastname: Snyder
authors.affiliation: Department of Radiology, Washington University, St. Louis, MO, USA.
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Christensen
authors.affiliation: Department of Neurology, Washington University, St. Louis, MO, USA.
authors.forename: Jewell
authors.initials: J
authors.lastname: Carter
authors.affiliation: Department of Neurology, Washington University, St. Louis, MO, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Vahle
authors.affiliation: Department of Neurology, Penn State University, Hershey, PA, USA.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gilliam
mesh_terms: D000328:Adult; D001284:Atrophy / Q000150:complications / Q000473:pathology / Q000523:psychology; D003863:Depression / Q000150:complications / Q000473:pathology* / Q000523:psychology; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000473:pathology* / Q000523:psychology; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011569:Psychiatric Status Rating Scales
keywords: Beck Depression Inventory; Depression; Hippocampus; Quantitative MRI; Temporal lobe epilepsy