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. 2025 Jan 15;272(2):130.
doi: 10.1007/s00415-024-12806-2.

Temporal lobe epilepsy with isolated amygdala enlargement: anatomo-electro-clinical features and long-term outcome

Margarida Ferro  1 , João Nuno Ramos  2   3 , Elisa Visani  4 , Margherita Bevilacqua  5 , Rita Garbelli  4 , Valeria Cuccarini  6 , Dalila Biancheri  4 , Gianluca Marucci  7 , Angelo Del Sole  8 , Michele Rizzi  9 , Flavio Villani  10 , Francesco Deleo  4 , Andrea Stabile  4 , Annalisa Parente  4 , Chiara Pastori  4 , Rosalba Ferrario  4 , Roberta Di Giacomo  4 , Rui Quintas  4 , Marco de Curtis  4 , Fabio Martino Doniselli  6 , Giuseppe Didato  11
Affiliations

Temporal lobe epilepsy with isolated amygdala enlargement: anatomo-electro-clinical features and long-term outcome

Margarida Ferro et al. J Neurol. .

Abstract

Background: Temporal lobe epilepsy with isolated amygdala enlargement (TLE-AE) still lacks a definite characterization and controversies exist.

Methods: We conducted a retrospective study identifying brain MRI scans with isolated AE between 2015 and 2021. We collected clinical and paraclinical data of patients with TLE-AE and evaluated the outcome.

Results: Forty-one subjects were included (20 males; AE: right 13; left 24; bilateral 4). A strong correlation was found between AE and MRI T2-hyperintensity (right: p < 0.005; left: p < 0.003). There was no history of febrile seizures; 85,4% had focal seizures with impaired awareness, 78,1% reported auras (epigastric sensation, déjà-vu, anxiety), 37% had psychiatric disturbances, 48,6% presented with cognitive impairment. We report that AE correlates with FDG-PET temporomesial hypometabolism (right: p = 0.022; left: p = 0.053), temporal interictal activity on EEG (n = 41), and temporal ictal findings during long-term video-EEG monitoring (n = 23). Epilepsy surgery (n = 17) revealed gliosis (n = 4), inflammatory infiltrates (n = 4), or low-grade epilepsy-associated neuroepithelial tumors (n = 5) in the amygdala. Other treatments were immunotherapy (n = 6) and only antiseizure medications (n = 17), with good prognosis (58,1% seizure-free and 17,1% only with auras at last follow-up). There was no correlation between longitudinal changes in seizure frequency and amygdala size (p = 0.848) and T2-hyperintensity (p = 0.909).

Conclusions: AE should be searched in TLE patients with typical aura, psychiatric and/or neurocognitive disturbances. The strong correlations found between AE lateralization and neurophysiological, FDG-PET, and MRI data support involvement of AE in the epileptogenic network. Drug resistance should prompt presurgical study. Inflammation in amygdala specimens and response after immunotherapy suggest an immune-mediated etiology in some TLE-AE cases.

Keywords: Amygdala enlargement; Epilepsy surgery; Immune-mediated epilepsy; Temporal lobe epilepsy.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors declare that they have no conflict of interest. Ethical approval: This study was done in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration. Informed consent: Patients signed an informed consent, accepting the anonymous collection of their clinical data.

References

    1. Chowdhury FA, Silva R, Whatley B et al (2021) Localisation in focal epilepsy: a practical guide. Pract Neurol 21:481–491 - DOI - PubMed
    1. Riney K, Bogacz A, Somerville E et al (2022) International League against epilepsy classification and definition of epilepsy syndromes with onset at a variable age: position statement by the ilae task force on nosology and definitions. Epilepsia 63:1443–1474 - DOI - PubMed
    1. Qais AbuHasan, Vamsi Reddy, Waquar Siddiqui. Neuroanatomy, Amygdala. Treasure Island (FL): StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK537102/ (2024, accessed 29 February 2024).
    1. Yilmazer-Hanke D, O’Loughlin E, Mcdermott K (2016) Contribution of amygdala pathology to comorbid emotional disturbances in temporal lobe epilepsy. J Neurosci Res 94:486–503 - DOI - PubMed
    1. Coan AC, Morita ME, de Campos BM et al (2013) Amygdala enlargement in patients with mesial temporal lobe epilepsy without hippocampal sclerosis. Front Neurol. https://doi.org/10.3389/fneur.2013.00166 - DOI - PubMed - PMC

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