Gray, White Matter Concentration Changes and Their Correlation with Heterotopic Neurons in Temporal Lobe Epilepsy

태우석,주은연,김성태,홍승봉 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.1

Objective: To identify changes in gray and white matter concentrations (GMC, WMC), and their relation to heterotopic neuron numbers in mesial temporal lobe epilepsy (mTLE). Materials and Methods: The gray matter or white matter concentrations of 16 left and 15 right mTLE patients who achieved an excellent surgical outcome were compared with those of 24 healthy volunteers for the left group and with 23 healthy volunteers for the right group, by optimized voxel-based morphometry using unmodulated and modulated images. A histologic count of heterotopic neurons was obtained in the white matter of the anterior temporal lobe originating from the patients’ surgical specimens. In addition, the number of heterotopic neurons were tested to determine if there was a correlation with the GMC or WMC. Results: The GMCs of the left and right mTLE groups were reduced in the ipsilateral hippocampi, bilateral thalami, precentral gyri, and in the cerebellum. The WMCs were reduced in the ipsilateral white matter of the anterior temporal lobe, bilateral parahippocampal gyri, and internal capsules, but increased in the pons and bilateral precentral gyri. The heterotopic neuron counts in the left mTLE group showed a positive correlation (r = 0.819, p < 0.0001) with GMCs and a negative correlation (r = - 0.839, p < 0.0001) with WMCs in the white matter of the anterior temporal lobe. Conclusion: The present study shows the abnormalities of the cortico-thalamo-hippocampal network including a gray matter volume reduction in the anterior frontal lobes and an abnormality of brain tissue concentration in the pontine area. Furthermore, heterotopic neuron numbers were significantly correlated with GMC or WMC in the left white matter of anterior temporal lobe. Objective: To identify changes in gray and white matter concentrations (GMC, WMC), and their relation to heterotopic neuron numbers in mesial temporal lobe epilepsy (mTLE). Materials and Methods: The gray matter or white matter concentrations of 16 left and 15 right mTLE patients who achieved an excellent surgical outcome were compared with those of 24 healthy volunteers for the left group and with 23 healthy volunteers for the right group, by optimized voxel-based morphometry using unmodulated and modulated images. A histologic count of heterotopic neurons was obtained in the white matter of the anterior temporal lobe originating from the patients’ surgical specimens. In addition, the number of heterotopic neurons were tested to determine if there was a correlation with the GMC or WMC. Results: The GMCs of the left and right mTLE groups were reduced in the ipsilateral hippocampi, bilateral thalami, precentral gyri, and in the cerebellum. The WMCs were reduced in the ipsilateral white matter of the anterior temporal lobe, bilateral parahippocampal gyri, and internal capsules, but increased in the pons and bilateral precentral gyri. The heterotopic neuron counts in the left mTLE group showed a positive correlation (r = 0.819, p < 0.0001) with GMCs and a negative correlation (r = - 0.839, p < 0.0001) with WMCs in the white matter of the anterior temporal lobe. Conclusion: The present study shows the abnormalities of the cortico-thalamo-hippocampal network including a gray matter volume reduction in the anterior frontal lobes and an abnormality of brain tissue concentration in the pontine area. Furthermore, heterotopic neuron numbers were significantly correlated with GMC or WMC in the left white matter of anterior temporal lobe.

Anterior Temporal Lobectomy with Tailored Hippocampectomy : Review of 100 cases with Intractable Temporal Lobe Epilepsy

Yoo, Young Sang,Son, Eun Ik 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.5

Gray, White Matter Concentration Changes and Their Correlation with Heterotopic Neurons in Temporal Lobe Epilepsy

Tae, Woo Suk,Joo, Eun Yun,Kim, Sung Tae,Hong, Seung Bong The Korean Society of Radiology 2010 KOREAN JOURNAL OF RADIOLOGY Vol.11 No.1

<P><B>Objective</B></P><P>To identify changes in gray and white matter concentrations (GMC, WMC), and their relation to heterotopic neuron numbers in mesial temporal lobe epilepsy (mTLE).</P><P><B>Materials and Methods</B></P><P>The gray matter or white matter concentrations of 16 left and 15 right mTLE patients who achieved an excellent surgical outcome were compared with those of 24 healthy volunteers for the left group and with 23 healthy volunteers for the right group, by optimized voxel-based morphometry using unmodulated and modulated images. A histologic count of heterotopic neurons was obtained in the white matter of the anterior temporal lobe originating from the patients' surgical specimens. In addition, the number of heterotopic neurons were tested to determine if there was a correlation with the GMC or WMC.</P><P><B>Results</B></P><P>The GMCs of the left and right mTLE groups were reduced in the ipsilateral hippocampi, bilateral thalami, precentral gyri, and in the cerebellum. The WMCs were reduced in the ipsilateral white matter of the anterior temporal lobe, bilateral parahippocampal gyri, and internal capsules, but increased in the pons and bilateral precentral gyri. The heterotopic neuron counts in the left mTLE group showed a positive correlation (<I>r</I> = 0.819, <I>p</I> < 0.0001) with GMCs and a negative correlation (<I>r</I> = -0.839, <I>p</I> < 0.0001) with WMCs in the white matter of the anterior temporal lobe. </P><P><B>Conclusion</B></P><P>The present study shows the abnormalities of the cortico-thalamo-hippocampal network including a gray matter volume reduction in the anterior frontal lobes and an abnormality of brain tissue concentration in the pontine area. Furthermore, heterotopic neuron numbers were significantly correlated with GMC or WMC in the left white matter of anterior temporal lobe.</P>

측두엽내 공간 점유 병소와 동반된 난치성 간질의 수술적 치료 성적

박준범,이완수,이정교,전상룡,김정훈,노성우,나영신,김창진,권양,임승철,권병덕,강중구,이상암,고태성,Park, Jun Bum,Lee, Wan Su,Lee, Jung Kyo,Jeon, Sang Ryong,Kim, Jeong Hoon,Roh, Sung Woo,Ra, Young Shin,Kim, Chang Jin,Kwon, Yang,Rhim, Seung Chul 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : The increasing use of sensitive neuroimaging techniques has demonstrated that significant percentage of patients with intractable complex partial seizures have brain masses, especially in temporal lobe. The optimal surgical solution for these patients is still open to debate. The purpose of our investigation is to evaluate the surgical outcome of patient with lesion-related temporal lobe epilepsy with respect to the types of surgery and the location of lesion. Patients and Methods : From DEC. 1993 to Dec. 1997, 35 patients with intractable epilepsy and space occupying temporal lobe lesion identified in preoperative MRI were included in this study. The types of surgery were lesionectomy, anterior temporal lobectomy with or without hippocampectomy. The location of lesion was divided as anteromedial group and lateral cortical group. The postoperative seizure outcomes according to the type of surgery and location of the lesion were compared. Results : Twenty-six of 34 patients(76.5%) were seizure-free after surgery. The Engel's class was favorable after anterior temporal lobectomy with or without hippocampectomy(p=.044) Conclusion : It is favorable to perform anterior temporal lobectomy for the treatment of intractable epilepsy with space-occipying lesion in temporal lobe. The resection of the hippocampus can be individualized.

소아 측두엽 간질의 임상 양상

정고운(Go Un Jeong),조안나(An Na Cho),이진숙(Jin Sook Lee),박지윤(Jee Yoon Park),문진화(Jin Hwa Moon),황희(Hee Hwang),황용승(Yong Seung Hwang),김기중(Ki Joong Kim),채종희(Jong Hee Chae) 대한소아신경학회 2006 대한소아신경학회지 Vol.14 No.2

목 적 : 비교적 전형적인 임상양상을 보이는 성인의 측두엽과는 달리 소아의 측두엽 간질은 정보가 부족하다. 소아의 측두엽 간질의 정의가 내려져 있지 않고 전기생리현상과 임상양상, 병리 소견과의 상관관계도 명확하지 않다. 난치성 측두엽 간질로 수술을 받은 소아 환자를 대상으로 임상 양상, 뇌신경영상, 뇌파 및 수술 소견 등을 기술하였고 소아 측두엽 간질의 특징을 정의하고 뇌파와 병리 소견 사이의 관계를 비교해보고자 하였다. 방 법 : 1995년 1월부터 2005년 12월까지 서울대학교 병원에서 난치성 간질로 수술을 받았던 17세 이하의 측두엽 간질환자 중에서 Engel class II 이상이었던 18명을 대상으로 하여 이들의 연령 및 성별 분포, 경련 발작의 임상적 특징, 원인 질환, 수술 치료 및 경과 등에 대해 조사하였다. 모든 환아에서 MRI, SPECT, PET 검사 소견과 뇌파, 병리 소견을 비교하였다. 결 과: 소아의 난치성 측두엽 간질의 수술 요법은 성적이 우수하였다. 소아의 측두엽 간질은 성인과 달리 외측두엽 간질이 대부분(61.1%)이었고 원인 질환이 두 가지 이상인 경우(44.4%)가 흔하였다. MRI는 병리 소견을 예측할 수 있는 지표가 되지 못하였다. 발작 양상은 전형적인 측두엽 간질보다 복잡하였고 손의 이긴장증이나 강직, 고개 돌리기는 편측화에 도움이 되었다. 뇌파 소견과 병변이 항상 일치하는 것은 아니었고 이는 외측두엽 간질에서 보다 뚜렷하였다. 발작파가 델타파로 시작하는 경우 외측두엽 간질을 의심할 수 있었고 측두엽의 앞쪽에서 시작하는 경우에는 내측두엽 간질을 시사하였다. 신경절교종은 규칙적인 베타파로 시작하는 경향이 있었다. 결 론: 소아의 측두엽 간질은 성인보다 복잡한 임상 양상을 보이며 원인 질환이 다양하여 쉽게 편측화, 국소화할 수 없다. 따라서 정밀한 국소화를 통해 절제 부위를 정하기 위해서는 임상 양상, 신경방사선학적 소견, 뇌파 소견 등을 종합적으로 평가해야 할 것이다. Purpose : Temporal lobe epilepsy(TLE) is now recognized as a distinct syndrome in adults. The seizure evolution in adult patients is well characterized, manifesting initially with an aura, behavioral arrest, automatism, and secondary generalized tonic-clonic seizures. In contrast, relatively few studies are available for the pediatric age group. In the present study, we investigated children undergoing temporal lobectomy for refractory seizures and correlated the pathologic findings with clinical presentations. Methods : The records of the pediatric patients admitted at the Seoul National Children's Hospital for epilepsy surgery between January 1995 and December 2005 were reviewed. Then, eighteen patients were included in this study. The clinical records were reviewed in terms of the patient profiles imaging findings, surgical techniques, and pathologic findings. The seizure outcomes were described according to the Engel's classification. Results : The postsurgical outcomes were favorable. Lateral temporal epilepsy was more common in childhood than in adulthood. Dual pathology was commonly found. Arm dystonia or tonic arm elevation have a lateralizing value. Head turning may have a lateralizing value based upon a time sequence. The brain MRI was less predictable for pathologic findings. The ictal EEG cannot always have a localizing value. Delta beginning in the ictal rhythm may suggest lateral lobe epilepsy. Anterior temporal beginning of the ictal location may suggest mesial temporal lobe epilepsy. Ganglioglioma tends to cause rhythmic beta activities at the beginning of the ictal event. Conclusion : TLE in childhood shows more complex and atypical clinical manifestations and have more variable etiologies. No single presurgical investigation can be a good predictable value to localization or lateralization.

앞안쪽관자엽절제술 후 발작이 지속된 간질 환자의수술 후 전기임상적 특성

서대원 대한신경과학회 2008 대한신경과학회지 Vol.26 No.4

ackground: Anteromesial temporal resection (AMTR) is well established as effective in patients with intractable mesial temporal epilepsy. However, little electroclinical information is available relevant to poor surgical outcome after AMTR. We examined the postoperative electroclinical features based on postoperative MRI and video-EEG monitoring (VEM) in patients with poor surgical outcome. Methods: We reviewed clinical features and postoperative VEM results in 20 patients with failure in AMTR. According to the postoperative electroclinical features, we classified them into mesial temporal (MT), bitemporal (BT), extramesial temporal (XMT), combined (C), and unclassified groups. The postoperative VEM results were compared among the groups. Surgical outcome was assessed in five patients who underwent reoperation. Results: Patients comprised 6 MT, 2 BT, 6 XMT, 1 C, and 6 unclassified. Aura and automatism were more frequent in MT (50.0%, 83.3%) than in XMT (16.7%, 33.3%). Theta to delta rhythm, during the ictal onset and build-up period, was more frequent in MT (83.3%, 66.7%) than in XMT (33.3%, 33.3%). The ictal onset and build-up pattern of ictal EEG were most frequently localized to the frontotemporal region in MT (66.7%, 100.0%), while there was no predominantly localized region in XMT. The surgical outcome after reoperation was better in MT group than in XMT and C groups. Conclusions: Postoperative MRI and VEM are useful to assess the postoperative electroclinical features in failed AMTR. Reoperation of the residual mesiotemporal structures after confirming epileptogenic foci may have good surgical outcome. ackground: Anteromesial temporal resection (AMTR) is well established as effective in patients with intractable mesial temporal epilepsy. However, little electroclinical information is available relevant to poor surgical outcome after AMTR. We examined the postoperative electroclinical features based on postoperative MRI and video-EEG monitoring (VEM) in patients with poor surgical outcome. Methods: We reviewed clinical features and postoperative VEM results in 20 patients with failure in AMTR. According to the postoperative electroclinical features, we classified them into mesial temporal (MT), bitemporal (BT), extramesial temporal (XMT), combined (C), and unclassified groups. The postoperative VEM results were compared among the groups. Surgical outcome was assessed in five patients who underwent reoperation. Results: Patients comprised 6 MT, 2 BT, 6 XMT, 1 C, and 6 unclassified. Aura and automatism were more frequent in MT (50.0%, 83.3%) than in XMT (16.7%, 33.3%). Theta to delta rhythm, during the ictal onset and build-up period, was more frequent in MT (83.3%, 66.7%) than in XMT (33.3%, 33.3%). The ictal onset and build-up pattern of ictal EEG were most frequently localized to the frontotemporal region in MT (66.7%, 100.0%), while there was no predominantly localized region in XMT. The surgical outcome after reoperation was better in MT group than in XMT and C groups. Conclusions: Postoperative MRI and VEM are useful to assess the postoperative electroclinical features in failed AMTR. Reoperation of the residual mesiotemporal structures after confirming epileptogenic foci may have good surgical outcome.

난천성 측두엽간질의 발작간 뇌혈류 SPECT , MRI 와 수술성과 비교

전석길,주양구,이상도,손은익,이영환 ( Seok Kil Zeon,Yang Goo Joo,Sang Doe Lee,Eun Ik Son,Young Hwan Lee ) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.3

Interictal single photon emission computed tomography of regional cerebral blood flow (rCBF SPECT) in 18 intractable temporal lobe epilepsy patient,s(8 male and 10 female patients : average 23.5 years old) were eompared with 2.0 T magnetic resanance imaging (MRI). And surgical outcome was analysed with the findings, symptom duration and lateralization of temporal lobe. Preoperatively rCRF SPKCT was done in all 18 patients with intravenous injection of 740 MRq 99mTc HMPAO. MRI was also done preoperatively in 13 patients, Surgical outcome was classified by Engels outcome classification (four part classification recommended at the first Palm Desert conference). rCRF SPECT detected correctly lateralising abnormality of temporal lobe hypoperfusion in 13/ 18(72.2%), contralateral temporal lobe hypoperfusion in 2/18(11.1%) and showed no definite abnormality in 3/18(16.7%). The positive predictive value of unilateral temporal lobe hypoperfusion was 87%. MRI detected correct localising abnormality in 8/13(61.5%), such as hippocampal atrophy(7/13), asymmetric temporal horn(6/13), anterior t,emporal lobe atrophy(1/13), increased signal intensity from hippocampus(1/13) and ealcific density(3/13), and no abnormal finding was noted in 5/13(38.5%), There was no false positive findings and the positive predictive value of MRI was 100%, Only 2 cases showed same lateralization findings in rCBF SPECT and MRI. There was no significant correlation between symptom duration and no abnormal findings on SPECT or MRI. Surgical outcome showed elass 1 in 15/18(83.3%), and class II in 2/18(11.1%). One case of no abnormal finding in both SPECT and MRI showed elass I1I surgical outcome. No class IV surgical out.come was noted. Surgical outcome, lat.eralization of epileptic focus in temporal lobe and abnormal findings in rCBR SPECT or MRI were not significantly correlated.

측두엽간질 환자에서 보이는 정신병리의 특성

김창윤,이철,안준호,박인호,한오수 울산대학교 의과대학 1995 울산의대학술지 Vol.4 No.2

The diagnostic tools and treatment modalities for epilepsies are growing in recent years. Therefore many investigators are studying the relationship of ipilepsy and psychopathology. These efforts are not only for the understanding of and therapeutic approach to psychiatric disorder in epileptic patients but also seeking the etiological basis of psychopathologies. Method 45 patients who were diagnosed as temporal lobe epilepsy by brain MRI and EEG etc were investigated, and offered psychiatric diagnosis. Also we took detailed psychiatric histories and investigated the characteristic features of psychiatric disorders in temporal lobe epilepsy. We evaluated several variables, i.e., age, sex, duration of epilepsy, age at first seizure, age at onset of epilepsy, time between first seizure and onset of epilepsy, seizure frequency, history of febrile convulsions, history of clustering seizures, and laterality of focus of these 45 subjects. Futher investigations divided 45 subjects into a group without psychiatric disorder, a group with mood disorder and a group with psychotic disorder. And we compared those variables among these 3 groups. Among 45 subjects, nine were diagnosed as psychotic disorders, five were mood disorders, and two were anxiety disorders. Among 9 subjects with psychotic disorders, six were diagnosed as psychotic disorder NOS, and the other three were schizophrenia. And they manifested unique clinical features in relations to epileptic seizures. Among 5 subjects with mood disorders, 4 subjects were diagnosed as dysthymia with chronic depression and 1 subject were major depression. We compared all variables between the group without psychiatric disorder and the group with psychotic disorder however we can't find any statistically significant differences except one variable. In the group with psychotic disorder, all subjects had the history of clustering of seizures in the rate of 100% of cases, but 54.6% of cases of the group without psychiatric disorder. The statistical difference was significant(p=0.016). It is a preliminary study in this field in Korea. However this study will help to understand the various psychiatric symptoms of the patients with temporal lobe epilepsy and will help to promote further investigations in this field.

Ictal Spitting을 보이는 열성 반구 측두엽 간질 환자 3례

주종규,허경,주민경,이미희,박수철,이병인,장진우 대한간질학회 2003 대한간질학회지 Vol.7 No.1

Changes in Central Auditory Processing in Patients with Mesial Temporal Lobe Epilepsy after Anterior Temporal Lobectomy with Amygdalohippocampectomy

한수현,이은미,류한욱,강중구,정종우 대한신경과학회 2016 Journal of Clinical Neurology Vol.12 No.2

Background and Purpose This study aimed to determine the effects of anterior temporal lobectomy with amygdalohippocampectomy (ATL-AH) on central auditory processing (CAP) in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS), and to identify factors that may contribute to the postoperative worsening of CAP. Methods Frequency-pattern, duration-pattern, and dichotic tests were performed before and after epilepsy surgery in 22 patients with normal hearing according to pure-tone audiometry. Results No significant difference in CAP scores was detected between pre- and postoperative tests, but there was a strong association between surgery in the language-dominant temporal lobe and postoperative worsening in the non-dominant-side dichotic test (p<0.05). The probability of a decreased performance in a non-dominant-side dichotic test after surgery was 7.5-fold greater in patients who underwent surgery on the dominant temporal lobe compared with the nondominant temporal lobe. No significant association of postoperative worsening in CAP with the verbal, nonverbal intelligence quotient, or right- or left-side lobectomy was noted. Conclusions These results suggest that ATL-AH on the dominant side in patients with mTLE-HS worsens the CAP ability in the non-dominant-side dichotic test.