Clinical Findings in Temporal Lobe Epilepsy Associated With Isolated Amygdala Enlargement

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2025-05-27 DOI:10.1111/ene.70225

Annika Kirscht, Johann Philipp Zöllner, Nadine Conradi, Elisabeth Neuhaus, Elke Hattingen, Marcus Belke, Susanne Knake, Laurent Willems, Jennifer Wichert, Andreas Jansen, Felix Rosenow, Adam Strzelczyk

{"title":"Clinical Findings in Temporal Lobe Epilepsy Associated With Isolated Amygdala Enlargement","authors":"Annika Kirscht, Johann Philipp Zöllner, Nadine Conradi, Elisabeth Neuhaus, Elke Hattingen, Marcus Belke, Susanne Knake, Laurent Willems, Jennifer Wichert, Andreas Jansen, Felix Rosenow, Adam Strzelczyk","doi":"10.1111/ene.70225","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Mesial temporal lobe epilepsy (mTLE) infrequently presents with isolated amygdala enlargement (AE), but its relevance remains ambiguous. We therefore investigated clinical, imaging, and histopathological findings in mTLE-AE compared to non-lesional mTLE (mTLE-NL) patients, and additionally strategies for identifying AE.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We detected AE by automated volumetry of otherwise unremarkable magnetic resonance images of mTLE patients, compared with a healthy comparator. Autoimmune inflammation as an AE cause was excluded using the Graus criteria. We compared clinical and neuropsychological variables between mTLE-AE and mTLE-NL. Secondary assessment of AE was by neuroradiologist visual detection.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 63 mTLE patients, 15 had mTLE-AE. In these, normalized mean volume was 1857.58 mm<sup>3</sup> (SD = 207.38) for the left, 1973.09 mm<sup>3</sup> (SD = 214.91) for the right amygdala, 2003.34 mm<sup>3</sup> (SD = 218.85) for the larger and 1827.34 mm<sup>3</sup> (SD = 179.85) for the smaller amygdala. Mean volume in the healthy control subjects was 1853.4 mm<sup>3</sup> for the left (SD = 212.44) and 1895.2 mm<sup>3</sup> for the right amygdala (SD = 224.29). Clinical parameters including age, sex, epilepsy duration, history of febrile convulsions, drug resistance, neuropsychological performance, surgical outcome, and medications did not differ significantly between mTLE-AE and mTLE-NL. Histopathological findings in mTLE-AE included dysmorphic neurons, potential tumors, and focal cortical dysplasia. Neuroradiologists independently described AE in 37 of 63 mTLE patients.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>mTLE-AE has no specific clinical profile compared to non-lesional mTLE and features diverse underlying pathologies. Volumetric detection appears more conservative than conventional qualitative visual analysis, but may miss cases of subtle AE. Combining automated volumetry with visual assessment may improve AE detection.</p>\n </section>\n </div>","PeriodicalId":11954,"journal":{"name":"European Journal of Neurology","volume":"32 6","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ene.70225","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/ene.70225","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Mesial temporal lobe epilepsy (mTLE) infrequently presents with isolated amygdala enlargement (AE), but its relevance remains ambiguous. We therefore investigated clinical, imaging, and histopathological findings in mTLE-AE compared to non-lesional mTLE (mTLE-NL) patients, and additionally strategies for identifying AE.

Methods

We detected AE by automated volumetry of otherwise unremarkable magnetic resonance images of mTLE patients, compared with a healthy comparator. Autoimmune inflammation as an AE cause was excluded using the Graus criteria. We compared clinical and neuropsychological variables between mTLE-AE and mTLE-NL. Secondary assessment of AE was by neuroradiologist visual detection.

Results

Of 63 mTLE patients, 15 had mTLE-AE. In these, normalized mean volume was 1857.58 mm³ (SD = 207.38) for the left, 1973.09 mm³ (SD = 214.91) for the right amygdala, 2003.34 mm³ (SD = 218.85) for the larger and 1827.34 mm³ (SD = 179.85) for the smaller amygdala. Mean volume in the healthy control subjects was 1853.4 mm³ for the left (SD = 212.44) and 1895.2 mm³ for the right amygdala (SD = 224.29). Clinical parameters including age, sex, epilepsy duration, history of febrile convulsions, drug resistance, neuropsychological performance, surgical outcome, and medications did not differ significantly between mTLE-AE and mTLE-NL. Histopathological findings in mTLE-AE included dysmorphic neurons, potential tumors, and focal cortical dysplasia. Neuroradiologists independently described AE in 37 of 63 mTLE patients.

Conclusions

mTLE-AE has no specific clinical profile compared to non-lesional mTLE and features diverse underlying pathologies. Volumetric detection appears more conservative than conventional qualitative visual analysis, but may miss cases of subtle AE. Combining automated volumetry with visual assessment may improve AE detection.

查看原文本刊更多论文

颞叶癫痫伴孤立性杏仁核增大的临床表现

背景：内侧颞叶癫痫（mTLE）很少表现为孤立性杏仁核增大（AE），但其相关性尚不清楚。因此，我们研究了mTLE-AE与非病变性mTLE （mTLE- nl）患者的临床、影像学和组织病理学结果，以及识别AE的策略。方法采用自动体积法对mTLE患者的磁共振图像进行AE检测，并与健康对照者进行比较。使用Graus标准排除自身免疫性炎症作为AE的原因。我们比较了mTLE-AE和mTLE-NL的临床和神经心理学变量。神经放射学家视觉检测对AE进行二次评估。结果63例mTLE患者中，15例发生mTLE- ae。其中，左侧扁桃核的标准化平均体积为1857.58 mm3 (SD = 207.38)，右侧扁桃核为1973.09 mm3 (SD = 214.91)，较大扁桃核为2003.34 mm3 (SD = 218.85)，较小扁桃核为1827.34 mm3 （SD = 179.85）。健康对照者左杏仁核平均体积为1853.4 mm3 (SD = 212.44)，右杏仁核平均体积为1895.2 mm3 （SD = 224.29）。mTLE-AE和mTLE-NL的临床参数包括年龄、性别、癫痫持续时间、热惊厥史、耐药性、神经心理表现、手术结果和药物治疗等均无显著差异。mTLE-AE的组织病理学结果包括神经元畸形、潜在肿瘤和局灶性皮质发育不良。神经放射学家独立描述了63例mTLE患者中37例AE。结论与非病变性mTLE相比，mTLE- ae没有特定的临床特征，具有多种潜在病理特征。体积检测比传统的定性视觉分析更保守，但可能会遗漏细微声发射的病例。将自动体积法与目视评估相结合可以提高声发射检测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).