This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Claude Adam, MD; Michel Baulac, MD; Jean-Marc Saint-Hilaire, MD; Jacqueline Landau, MD; Olivier Granat, MD; Dominique Laplane, MD

Arch Neurol. 1994;51(2):130-138.

Abstract
Objective
To determine the occurrence of magnetic resonance imaging-detected hippocampal atrophy (HA) in patients with partial epilepsy (temporal and extratemporal, cryptogenic, or symptomatic). Magnetic resonance imaging-detected HA has been demonstrated to be both sensitive and specific for hippocampal sclerosis in cryptogenic temporal lobe epilepsy.

Design
Patients' hippocampal formations were measured on a computerized system using Tl-weighted, 5-mm contiguous magnetic resonance coronal images made perpendicular to the hippocampus long axis. Hippocampal atrophy was defined on the basis of a normative asymmetry index and correlated with the epileptogenic focus defined by clinical, electroencephalographic, and magnetic resonance imaging (apart from HA) localizing data.

Patients and Control Subjects
Seventy patients with intractable complex partial seizures of temporal, extratemporal, or undefined origin and 21 healthy control subjects.

Results
Hippocampal atrophy was present in 70% of patients with cryptogenic temporal lobe epilepsy (TLE) (n=40), 44% of patients with symptomatic TLE (n=9), 29% of patients with extratemporal epilepsy (n=14), and 6% of unclassified patients (n=16). In the cryptogenic TLE category, HA was marked and usually concordant (93%) with electroencephalographic lateralization. Hippocampal atrophy was often mild in the extratemporal epilepsy category. With the use of a wider confidence interval (±3.1 SD instead of ±2.2 SD), HA specificity for TLE increased to 93%, HA specificity for lateralizing cryptogenic TLE reached 96%, and HA sensitivity for cryptogenic TLE stood almost unchanged (68%). We found a link between early convulsions and HA occurrence.

Conclusions
Hippocampal atrophy is a marker for TLE. Dual pathologic findings are detected in 44% of symptomatic TLE cases. Mild HA is rarely associated with extratemporal epilepsy. Magnetic resonance imaging-based hippocampal volumetric analysis is a useful method to localize the origin of partial complex seizures.

Author Affiliations
From the Hôpital de la Salpêtrière, Clinique des Maladies du Système Nerveux, Paris, France (Drs Adam, Baulac, Landau, Granat, and Laplane) and Service de Neurologie, Hôpital Notre-Dame, Montreal, Quebec (Dr Saint-Hilaire).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surgical outcome and prognostic factors of frontal lobe epilepsy surgery
Jeha et al.
Brain 2007;130:574-584.
ABSTRACT | FULL TEXT  

Hippocampal Volume in Patients With Alcohol Dependence
Agartz et al.
Arch Gen Psychiatry 1999;56:356-363.
ABSTRACT | FULL TEXT  

Volumetric Magnetic Resonance Imaging: Clinical Applications and Contributions to the Understanding of Temporal Lobe Epilepsy
Watson et al.
Arch Neurol 1997;54:1521-1531.
ABSTRACT  

Putative projection of phrenic afferents to the limbic cortex in humans studied with cerebral-evoked potentials
Straus et al.
J. Appl. Physiol. 1997;82:480-490.
ABSTRACT | FULL TEXT  

Specificity of Volumetric Magnetic Resonance Imaging in Detecting Hippocampal Sclerosis
Watson et al.
Arch Neurol 1997;54:67-73.
ABSTRACT  

Brain Imaging And Behavioral Outcome In Traumatic Brain Injury
Bigler
J Learn Disabil 1996;29:515-530.
ABSTRACT  

Striatopallidal and Thalamic Dystonia: A Magnetic Resonance Imaging Anatomoclinical Study
Lehericy et al.
Arch Neurol 1996;53:241-250.
ABSTRACT