title: White matter abnormalities differentiate severe from benign temporal lobe epilepsy.
abstract: OBJECTIVE
  Temporal and extratemporal white matter abnormalities have been identified frequently in patients with refractory mesial temporal lobe epilepsy (rMTLE). However, the identification of potential water diffusion abnormalities in patients with drug-responsive, benign MTLE (bMTLE) is still missing. The aim of this study was to identify markers of refractoriness in MTLE.
  
  
  METHODS
  The study group included 48 patients with bMTLE (mean age 42.8 + 13.5 years), 38 with rMTLE (mean age 41.7 + 14.1 years) and 54 healthy volunteers. Diffusion tensor imaging (DTI) was performed to measure mean diffusivity (MD) and fractional anisotropy (FA) in a regions-of-interest analysis comprising hippocampi and temporal lobe gray and white matter regions. The presence of hippocampal sclerosis (Hs) was assessed using automated magnetic resonance imaging (MRI) evaluation. For statistics we used chi-square test; two-tailed, two-sample t-test; and stratified linear regression.
  
  
  RESULTS
  The significant demographic differences between the two patient groups were sex (p = 0.003), duration of epilepsy (p = 0.003) and complex febrile convulsions (p = 0.0001). In rMTLE, temporal white matter MD was higher and FA lower, as compared to bMTLE. The analysis of diagnostic accuracy (area under the receiver operator characteristic [ROC] curve [AUC]) showed that FA had an AUC for discriminating patients affected from those unaffected by refractory MTLE of 74.0% (p < 0.001), a value that was higher than that of temporal MD (64.0%), hippocampus volume (65.0%), and Hs (66.0%).
  
  
  CONCLUSIONS
  We performed DTI measurements in MTLE and found a significant reduction of FA along the white matter of the temporal lobes in rMTLE, suggesting it as a valuable measure of refractoriness in MTLE.
authors.affiliation: Institute of Neurology, University Magna Graecia, Catanzaro, Italy.|Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Labate
authors.affiliation: Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cherubini
authors.affiliation: Research Unit, Institute of Clinical Physiology, National Research Council (IFC-CNR), Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Institute of Neurology, University Magna Graecia, Catanzaro, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Mumoli
authors.affiliation: Institute of Neurology, University Magna Graecia, Catanzaro, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Ferlazzo
authors.affiliation: Institute of Neurology, University Magna Graecia, Catanzaro, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Aguglia
authors.affiliation: Institute of Neurology, University Magna Graecia, Catanzaro, Italy.|Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Quattrone
authors.affiliation: Institute of Neurology, University Magna Graecia, Catanzaro, Italy.|Institute of Molecular Bioimaging and Physiology of the National Research Council (IBFM-CNR), Germaneto, Catanzaro, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gambardella
mesh_terms: D000328:Adult; D000368:Aged; D001931:Brain Mapping / Q000379:methods; D056324:Diffusion Tensor Imaging / Q000379:methods; D004569:Electroencephalography / Q000379:methods; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D066127:White Matter / Q000473:pathology* / Q000503:physiopathology*; D055815:Young Adult
keywords: Diffusion tensor imaging; Imaging alterations; Temporal lobe epilepsy