Larissa Botelho Gaça1, Maria Teresa Fernandes Castilho Garcia1, Gabriel Barbosa Sandim2, Idaiane Batista Assumption Leme3, Maria Helena Silva Noffs1, Henrique Carrete2, Ricardo Silva Centeno1, João Ricardo Sato4, Elza Márcia Targas Yacubian5. 1. Unidade de Pesquisa e Tratamento das Epilepsias, Department of Neurology and Neurosurgery of Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650, Vila Clementino, 04039-002 São Paulo, SP, Brazil. 2. Department of Diagnostic Imaging of Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, 04024-002 São Paulo, SP, Brazil. 3. Department of Psychiatry of Universidade Federal de São Paulo (UNIFESP), Rua Borges Lagoa, 570, Vila Clementino, 04038-0001 São Paulo, SP, Brazil. 4. Center of Mathematics, Computing and Cognition, Universidade Federal do ABC, Avenida dos Estados, 5001, 09210-580 São Paulo, SP, Brazil. 5. Unidade de Pesquisa e Tratamento das Epilepsias, Department of Neurology and Neurosurgery of Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650, Vila Clementino, 04039-002 São Paulo, SP, Brazil. Electronic address: yacubian@terra.com.br.
Abstract
OBJECTIVE: The objectives of this study were to verify in a series of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) if those with low intellectual quotient (IQ) levels have more extended areas of atrophy compared with those with higher IQ levels and to analyze whether IQ could be a variable implicated on a surgical outcome. MATERIAL AND METHODS: Patients (n=106) with refractory MTLE-HS submitted to corticoamygdalohippocampectomy (CAH) (57 left mesial temporal lobe epilepsy (MTLE); 45 males) were enrolled. To determine if the IQ was a predictor of seizure outcome, totally seizure-free (SF) versus nonseizure-free (NSF) patients were evaluated. FreeSurfer was used for cortical thickness and volume estimation, comparing groups with lower (<80) and higher IQ (90-109) levels. RESULTS: In the whole series, 42.45% of patients were SF (Engel Class 1a; n=45), and 57.54% were NSF (n=61). Total cortical volume was significantly reduced in the group with lower IQ (p=0.01). Significant reductions in the left hemisphere included the following: rostral middle frontal (p=0.001), insula (p=0.002), superior temporal gyrus (p=0.003), thalamus (p=0.004), and precentral gyrus (p=0.02); and those in the right hemisphere included the following: rostral middle frontal (p=0.003), pars orbitalis (p=0.01), and insula (p=0.02). Cortical thickness analysis also showed reductions in the right superior parietal gyrus in patients with lower IQ. No significant relationship between IQ and seizure outcome was found. CONCLUSIONS: This is the first study of a series of patients with pure MTLE-HS, including those with low IQ and their morphometric magnetic resonance imaging (MRI) features using FreeSurfer. Although patients with lower intellectual scores presented more areas of brain atrophy, IQ was not a predictor of surgical outcome. Therefore, when evaluating seizure follow-up, low IQ in patients with MTLE-HS might not contraindicate resective surgery.
OBJECTIVE: The objectives of this study were to verify in a series of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) if those with low intellectual quotient (IQ) levels have more extended areas of atrophy compared with those with higher IQ levels and to analyze whether IQ could be a variable implicated on a surgical outcome. MATERIAL AND METHODS:Patients (n=106) with refractory MTLE-HS submitted to corticoamygdalohippocampectomy (CAH) (57 left mesial temporal lobe epilepsy (MTLE); 45 males) were enrolled. To determine if the IQ was a predictor of seizure outcome, totally seizure-free (SF) versus nonseizure-free (NSF) patients were evaluated. FreeSurfer was used for cortical thickness and volume estimation, comparing groups with lower (<80) and higher IQ (90-109) levels. RESULTS: In the whole series, 42.45% of patients were SF (Engel Class 1a; n=45), and 57.54% were NSF (n=61). Total cortical volume was significantly reduced in the group with lower IQ (p=0.01). Significant reductions in the left hemisphere included the following: rostral middle frontal (p=0.001), insula (p=0.002), superior temporal gyrus (p=0.003), thalamus (p=0.004), and precentral gyrus (p=0.02); and those in the right hemisphere included the following: rostral middle frontal (p=0.003), pars orbitalis (p=0.01), and insula (p=0.02). Cortical thickness analysis also showed reductions in the right superior parietal gyrus in patients with lower IQ. No significant relationship between IQ and seizure outcome was found. CONCLUSIONS: This is the first study of a series of patients with pure MTLE-HS, including those with low IQ and their morphometric magnetic resonance imaging (MRI) features using FreeSurfer. Although patients with lower intellectual scores presented more areas of brain atrophy, IQ was not a predictor of surgical outcome. Therefore, when evaluating seizure follow-up, low IQ in patients with MTLE-HS might not contraindicate resective surgery.
Authors: Karin Gau; Charlotte S M Schmidt; Horst Urbach; Josef Zentner; Andreas Schulze-Bonhage; Christoph P Kaller; Niels Alexander Foit Journal: Neuroradiology Date: 2020-07-20 Impact factor: 2.804