Lateralizing Characteristics of Morphometric Changes to Hippocampus and Amygdala in Unilateral Temporal Lobe Epilepsy with Hippocampal Sclerosis

Abstract

Background andObjective: In the present study, a detailed investigation of substructural volume change in the hippocampus (HC) and amygdala (AMG) was performed and the association with clinical features in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) determined. Methods: The present study included 22 patients with left-sided TLE-HS (LTLE-HS) and 26 patients with right-sided TLE-HS (RTLE-HS). In addition, 28 healthy controls underwent high-resolution T2-weighted image (T2WI) and T1-weighted image (T1WI) MRI scanning. Subfield analysis of HC and AMG was performed using FreeSurfer version 6.0. Results: Patients with TLE-HS showed a decrease in the volume of substructures in both HC and AMG, and this change was observed on the contralateral side and the ipsilateral side with HS. The volume reduction pattern of substructures showed laterality-dependent characteristics. Patients with LTLE-HS had smaller volumes of the ipsilateral subiculum (SUB), contralateral SUB, and ipsilateral cortical nucleus of AMG than patients with RTLE-HS. Patients with RTLE-HS had reduced ipsilateral cornu ammonis (CA) 2/3 and contralateral cortico-amygdaloid transition area (CAT) volumes. The relationship between clinical variables and subregions was different based on the lateralization of the seizure focus. Focal to bilateral tonic-clonic seizures (FTBTCS) was associated with contralateral and ipsilateral side subregions only in LTLE-HS. The abdominal FAS was associated with the volume reduction of AMG subregions only in LTLE-HS, but the volume reduction was less than in patients without FAS. Conclusions: The results indicate that unilateral TLE-HS is a bilateral disease that shows different laterality-dependent characteristics based on the subfield analysis of HC and AMG. Subfield volumes of HC and AMG were associated with clinical variables, and the more damaged substructures depended on laterality in TLE-HS. These findings support the evidence that LTLE-HS and RTLE-HS are disparate epilepsy entities rather than simply identical syndromes harboring a mesial temporal lesion. In addition, the presence of FAS supports good localization value, and abdominal FAS has a high localization value, especially in patients with LTLE-HS.

Keywords: amygdala; hippocampal sclerosis; hippocampus; subfield analysis; temporal lobe epilepsy.

Figure 1

Decreased contralateral hippocampal volumes in patients with left TLE compared to ptients with right TLE (ipsilateral subiculum, contralateral subiculum, ipsilateral cortical nucleus of amygdala) and vice versa (ipsilateral CA2/3, contralateral Cortico-amygdaloid Transition Area). LTLE, left temporal lobe epilepsy with hippocampal sclerosis; RTLE, right temporal lobe epilepsy with hippocampal sclerosis; CA, cornu ammonis; DG, granule cell layer of dentate gyrus; SUB, subiculum; La, Lateral nucleus; Ba, Basal nucleus; AB, Accessory Basal; Ce, Central; Me, Medial; Co, Cortical; CAT, Cortico-amygdaloid Transition Area. * p-value < 0.05.

Figure 2

Subfield volume alterations associated with history of more than 10 SGTCS and abdominal aura in left temporal lobe epilepsy with hippocampal sclerosis. CA, cornu ammonis; DG, granule cell layer of dentate gyrus; SUB, subiculum; La, Lateral nucleus; Ba, Basal nucleus; AB, Accessory Basal; Ce, Central; Me, Medial; Co, Cortical; CAT, Cortico-amygdaloid Transition Area. * p-value < 0.05.