Longitudinal and cross-sectional analysis of atrophy in pharmacoresistant temporal lobe epilepsy
Longitudinal and cross-sectional analysis of atrophy in pharmacoresistant temporal lobe epilepsy
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DOI：
10.1212/01.wnl.0000345969.57574.f5
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发表时间：
2009-05-19
期刊：
影响因子：
9.9
通讯作者：
Bernasconi, N.
中科院分区：
文献类型：
--
作者：
Bernhardt, B. C.;Worsley, K. J.;Bernasconi, N.
背景：癫痫反复发作是否会导致脑损伤仍有争议。癫痫的疾病进展仅在少数以社区为基础的研究中进行了评估，这些研究涉及药物控制良好的癫痫患者。这些研究的结论是，癫痫并不一定会导致全球性的脑damage.Objective：为了跟踪新皮质萎缩的进展，在耐药性颞叶癫痫（TLE）使用纵向和横截面designs.Methods：使用一个完全自动化的测量皮质厚度的MRI，我们研究了一个同质样本的耐药性颞叶癫痫患者。在纵向分析中（n = 18），固定效应模型被用来量化皮质萎缩的平均扫描间隔为2.5年（范围= 7至90个月）。在横断面分析（n = 121）中，我们将癫痫持续时间和厚度相关联。分离正常老化的病理进展，我们比较了老化的影响，在颞叶癫痫健康controls.Results：纵向分析映射同侧颞极和中央和对侧眶额，岛，角区的进展。在病程超过14年的患者中，额中央和顶叶区域的萎缩进展比病程较短的患者更快。横断面研究显示，进行性萎缩的内侧和上外侧额叶，顶叶cortices.Conclusions：我们结合横断面和纵向分析，在耐药性颞叶癫痫患者表现出进行性新皮质萎缩的平均间隔为2.5年，这是不同于正常的老化，可能代表癫痫引起的损害。萎缩的累积特征强调了这组患者早期手术治疗的重要性。神经病学（R）2009; 72：1747-1754
Background: Whether recurrent epileptic seizures induce brain damage is debated. Disease progression in epilepsy has been evaluated only in a few community-based studies involving patients with seizures well controlled by medication. These studies concluded that epilepsy does not inevitably lead to global cerebral damage.Objective: To track the progression of neocortical atrophy in pharmacoresistant temporal lobe epilepsy (TLE) using longitudinal and cross-sectional designs.Methods: Using a fully automated measure of cortical thickness on MRI, we studied a homogeneous sample of patients with pharmacoresistant TLE. In the longitudinal analysis (n = 18), fixed-effect models were used to quantify cortical atrophy over a mean interscan interval of 2.5 years (range = 7 to 90 months). In the cross-sectional analysis (n = 121), we correlated epilepsy duration and thickness. To dissociate normal aging from pathologic progression, we compared aging effects in TLE to healthy controls.Results: The longitudinal analysis mapped progression in ipsilateral temporopolar and central and contralateral orbitofrontal, insular, and angular regions. In patients with more than 14 years of disease, atrophy progressed more rapidly in frontocentral and parietal regions that in those with shorter duration. The cross-sectional study showed progressive atrophy in the mesial and superolateral frontal, and parietal cortices.Conclusions: Our combined cross-sectional and longitudinal analysis in patients with pharmacoresistant temporal lobe epilepsy demonstrated progressive neocortical atrophy over a mean interval of 2.5 years that is distinct from normal aging, likely representing seizure-induced damage. The cumulative character of atrophy underlies the importance of early surgical treatment in this group of patients. Neurology (R) 2009; 72: 1747-1754