Mesial temporal lobe epilepsy with hippocampal sclerosis: comparative clinical and arterial spin labeling findings according to neocortical MRI changes.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-09-17 DOI:10.1007/s00234-025-03735-6

Sri Venkata Ganesh Viswanadh Kalaparti, Ashalatha Radhakrishnan, Deepti A Narasimhaiah, Rajalakshmi Poyuran, George C Vilanilam, Bejoy Thomas

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引用次数: 0

Abstract

Purpose: High-field strength MRI reveals that Mesial Temporal Sclerosis (MTS) can be divided into two entities-(1) MTLE-HS (Mesial Temporal lobe epilepsy with hippocampal involvement), (2) MTLE-HS[N] (Mesial temporal lobe epilepsy with hippocampal sclerosis, and neocortical changes). The purpose of the study was to identify clinical, electrophysiological, histopathological, post-operative outcome differences between these entities and evaluate the role of Arterial spin labeling (ASL) in this regard.

Methods: Prospective observational study in MTS-patients undergoing epilepsy protocol-MRI (including 3D-ASL with pseudo-continuous tagging), followed by anterior-temporal lobectomy + amygdalohippocampectomy (ATL + AH). Based on T2WI/3D-FLAIR MRI findings, patients were classified into MTLE-HS and MTLE-HS[N]. The ASL, clinical, VEEG, histopathological characteristics, postoperative outcomes were compared.

Results: The MTLE-HS[N] and MTLE-HS groups had 63 and 37 patients respectively. MTLE-HS[N] group showed earlier age of epilepsy onset (7.82 ± 6.19y vs. 11.12 ± 8.1y, P-value = 0.04) and higher incidence of neocortical epileptogenesis (66.67% vs. 13.51%, P-value < 0.001). Histopathology revealed diffuse temporal neocortical astrogliosis in all patients, myelin loss in some patients from both groups and neocortical dysplasia in 6 patients with no significant differences in individual histopathological characteristics or postoperative outcomes. Within the MTLE-HS[N] group, more patients with neocortical epileptogenesis had ASL abnormality (P < 0.05). Qualitative ASL abnormality was also seen in most (83.33%) patients with neocortical dysplasia.

Conclusion: Although MTLE-HS and MTLE-HS[N] show differences in certain clinical, electrophysiological features, the postoperative outcomes were not different. MRI cannot predict the histopathological substrate responsible for temporal neocortical changes. ASL may be useful in predicting neocortical epileptogenesis. It could also help to postulate the presence of dysplasia, although this needs further evaluation for confirmation.

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内侧颞叶癫痫伴海马硬化：根据新皮质MRI变化比较临床和动脉自旋标记的发现。

目的：高场强MRI显示，中颞叶硬化症（Mesial Temporal Sclerosis， MTS）可分为两个实体(1)MTLE-HS（累及海马的中颞叶癫痫），(2)MTLE-HS[N]（伴海马硬化的中颞叶癫痫及新皮层改变）。该研究的目的是确定这些实体之间的临床，电生理，组织病理学和术后结果差异，并评估动脉自旋标记（ASL）在这方面的作用。方法：前瞻性观察研究mts患者接受癫痫方案- mri（包括3D-ASL伪连续标记），随后进行前颞叶切除术+杏仁核海马切除术（ATL + AH）。根据T2WI/3D-FLAIR MRI表现，将患者分为MTLE-HS和MTLE-HS[N]。比较两组患者的ASL、临床、VEEG、组织病理学特征及术后预后。结果：MTLE-HS[N]组63例，MTLE-HS组37例。MTLE-HS[N]组癫痫发病年龄更早（7.82±6.19岁∶11.12±8.1岁，p值= 0.04），新皮层癫痫发生发生率更高（66.67%∶13.51%，p值）。结论：MTLE-HS与MTLE-HS[N]组虽然在某些临床、电生理特征上存在差异，但术后结局无差异。MRI不能预测颞叶新皮层变化的组织病理学基础。ASL可能有助于预测新皮质癫痫的发生。这也有助于推测发育不良的存在，尽管这需要进一步的评估来证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.