title: Early childhood trauma and hippocampal volumes in patients with epileptic and psychogenic seizures.
abstract: Exposure to early life childhood trauma has been implicated as resulting in a vulnerability to epileptic and psychogenic nonepileptic seizures (PNES), hippocampal atrophy, and psychiatric disorders. This study aimed to explore the relationships between childhood trauma, epilepsy, PNES, and hippocampal volume in patients admitted to a video-electroencephalogram monitoring (VEM) unit.
  
  
  
  One hundred thirty-one patients were recruited from the Royal Melbourne Hospital VEM unit. The diagnostic breakdown of this group was: temporal lobe epilepsy (TLE) (32), other epilepsy syndromes (35), PNES (47), other nonepileptic syndromes (5), both epilepsy and PNES (6), and uncertain diagnosis (6). All patients completed a questionnaire assessing exposure to childhood trauma, the Childhood Trauma Questionnaire (CTQ), as well as questionnaires assessing psychiatric symptomatology (SCL-90-R), Anxiety and Depression (HADS), quality of life (QOLIE-98) and cognition (NUCOG). Volumetric coronal T1 MRI scans were available for 84 patients. Hippocampal volumes were manually traced by a blinded operator.
  
  
  
  The prevalence of childhood trauma in patients with PNES was higher than in patients with other diagnoses (p=0.005), and the group with PNES overall scored significantly higher on the CTQ (p=0.002). No association was found between CTQ scores and hippocampal volumes; however, patients with a history of sexual abuse were found to have smaller left hippocampal volumes than patients who had not (p=0.043). Patients reporting having experienced childhood trauma scored lower on measures of quality of life and higher on measures of psychiatric symptomatology.
  
  
  
  Patients with PNES report having experienced significantly more childhood trauma than those with epileptic seizures, and in both groups there was a relationship between a history of having experienced sexual abuse and reduced left hippocampal volume. Patients with PNES and those with epilepsy who have a history of childhood trauma have overall worse quality of life and more psychiatric symptomatology.
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Johnstone
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
authors.forename: Dennis
authors.initials: D
authors.lastname: Velakoulis
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
authors.forename: Cheng Yi
authors.initials: CY
authors.lastname: Yuan
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Ang
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Steward
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Desmond
authors.affiliation: The Departments of Medicine, Radiology, Neurology and Psychiatry, The Royal Melbourne Hospital, The University of Melbourne, Victoria, Australia. Electronic address: obrientj@unimelb.edu.au.
authors.forename: Terence J
authors.initials: TJ
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000706:statistics & numerical data*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006624:Hippocampus / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011602:Psychophysiologic Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012640:Seizures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D013001:Somatoform Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology
keywords: Early life trauma; Epilepsy; Hippocampus; Psychogenic nonepileptic seizures; Temporal lobe