Hippocampal Atrophy Pattern and Hippocampal Volume in Mesial Temporal Sclerosis: Correlation with Risk Factors and Surgical Outcome

J Korean Neurol Assoc > Volume 18(6); 2000 > Article

Journal of the Korean Neurological Association 2000;18(6): 694-699.

내측두경화증의 해마 위축의 형태와 해마 용적:위험 인자 및 수술 후 발작 예후와의 연관성

이상암, 강중구 ·이정교*·이호규†

울산대학교 의과대학 서울중앙병원 신경과,신경외과*,방사선과†

Hippocampal Atrophy Pattern and Hippocampal Volume in Mesial Temporal Sclerosis: Correlation with Risk Factors and Surgical Outcome

Sang-Ahm Lee, M.D., Joong Koo Kang, M.D., Jung-Kyo Lee, M.D.*, Ho Kyu Lee, M.D.†

Department of Neurology, Neurosurgery* & Neuroradiology† , Asan Medical Center, University of Ulsan College of Medicine

Abstract

Background : Hippocampal sclerosis (HS) is the most common cause of temporal lobe epilepsy (TLE). However, the regional distribution pattern and volume loss of HS and its clinical significance are still controversial. We investigated the regional distribution of hippocampal atrophy (HA) and the volume loss of HS and correlated these data with several clinical factors including seizure risk factor and surgical outcome. M e t h o d s : MRI volumetry was performed on 40 patients with TLE and pathologically proven HS and 20 control subjects using PACS system. The patterns of HA were categorized into diffuse and regional types. The clinical factors included were : age at onset, seizure duration, sex, histo-ry of febrile convulsion, and meningoencephalitis. MR volumetry data representing volume loss and pattern of HA were analyzed looking at surgical outcome and clinical factors. Results : 1) The MRI volumetry of hippocampus was highly sensitive and specific (above 95%) for HS. 2) Diffuse HA involving both the hippocampal head and body was slightly more common (56%) than the regional pattern. Regional atrophy was usually found in the hippocampal body. 3) The history of meningitis/encephalitis was significantly associated with diffuse atrophy (p=0.034). 4) The age at seizure onset was correlated with the degree of HA (r=0.460, p=0.003). 5) The pattern and severity of HA were not related to surgical outcome. Conclusions : The variable patterns of HA exist in mesial temporal sclerosis. They may be related to various clinical factors and the underlying epileptogenic process.J Korean Neurol Assoc 18(6):694~699, 2000Key Words : Mesial temporal sclerosis, Hippocampal atrophy, MR volumetry, Risk factor, Surgical outcome