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Robin L. Gilmore, MD; M. Douglas Childress, MD; Christiana Leonard, PhD; Ronald Quisling, MD; Steven Roper, MD; Stephan Eisenschenk, MD; Melissa Mahoney

Arch Neurol. 1995;52(8):819-824.

Abstract
Objective
To determine whether the occurrence of hippocampal formation (HF) volumetric asymmetry can reliably discriminate between complex partial seizures (CPSs) of a temporal lobe origin and CPSs of an extratemporal lobe origin in a prospective study of patients with intractable CPSs (approximately 70% of patients have electrographic foci in the temporal lobe [HF volumetric asymmetry on magnetic resonance imaging scans has been shown to lateralize such foci reliably]).

Design
We examined HF volumetrics on magnetic resonance imaging scans that were acquired with a 1-T magnetic resonance imaging scanner (Siemens Magnetom, Siemens Medical Systems, Iselin, NJ) by using magnetization-prepared rapid gradient echo threedimensional sequences (producing a gapless series of high-contrast 1.25-mm images). These data were compared with ictal, interictal, invasive, and noninvasive videoelectroencephalographic monitoring data, functional imaging data, and outcome data to define each patient's type of epilepsy.

Setting and Patients
Forty-one patients were recruited from a tertiary university comprehensive epilepsy program, and 22 control subjects were recruited from the neurologically normal university community.

Results
Among the control subjects, the difference in HF volumetrics (right-left HF volumetrics) was +0.085±0.253 cm³. Of the 41 patients, 25 had temporal lobe epilepsy. When we set the upper limit of normal at the mean±3 SDs, all patients beyond the upper limit had CPSs of a temporal lobe origin. Of the patients with temporal lobe epilepsy, only three fell within normal limits. No patient with CPSs of an extratemporal lobe origin fell beyond the upper limit.

Conclusion
The presence of significant HF volumetric asymmetry makes it highly unlikely that a patient's CPSs are of an extratemporal lobe origin.

Author Affiliations
From the Departments of Neurology (Drs Gilmore, Childress, and Eisenschenk, and Ms Mahoney), Neurosciences (Dr Leonard), Psychology (Dr Leonard), Radiology (Dr Quisling), and Neurosurgery (Dr Roper), College of Medicine, University of Florida, Gainesville.

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