Long term sequelae of amygdala enlargement in temporal lobe epilepsy. (January 2020)

• Record Type: Journal Article
• Authors: Peedicail, Joseph Samuel; Sandy, Sherry; Singh, Shaily; Hader, Walter; Myles, Terence; Scott, James; Wiebe, Samuel; Pillay, Neelan
• Is Part Of: Seizure. Volume 74(2019)
• Page Start: 33
• Page End: 40
• Publication Date: 2020-01
• Subjects: AE amygdala enlargement -- AED antiepileptic drug -- AH amygdalohippocampectomy -- ATL anterior temporal lobectomy -- CSF cerebrospinal fluid -- FCD focal cortical dysplasia -- HE hippocampal enlargement -- HS hippocampal sclerosis -- IED interictal epileptiform discharge -- MRI magnetic resonance imaging -- MRS magnetic resonance spectroscopy -- MTLE mesial temporal lobe epilepsy -- TLE temporal lobe epilepsy; Amygdala -- Enlargement -- Temporal lobe epilepsy; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2019.11.015
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Amygdala enlargement may be associated with hippocampal enlargement. Most common pathology is amygdala gliosis. Resolution of amygdala enlargement is associated with better prognosis. Abstract: Purpose: Amygdala enlargement (AE) has been reported in drug resistant lesional and non-lesional temporal lobe epilepsy (TLE). Its contribution to development of intractability of epilepsy is at best uncertain. Our aim was to study the natural course of AE in a heterogenous group of TLE patients with follow-up imaging and clinical outcomes. Methods: A prospective observational study in patients with TLE with imaging features of AE recruited from epilepsy clinics between 1994 and 2018. Demographic data, details of epilepsy syndrome, outcomes and follow up neuroimaging were extracted. Results: Forty-two patients were recruited including 19 males (45 %). Mean age at onset of epilepsy was 30.6 years and mean duration of epilepsy was 19.9 years. On MRI, 33 patients had isolated unilateral AE and eleven had AE with hippocampal enlargement (HE). Twenty (48 %) underwent temporal resections with most common histopathology being amygdalar gliosis (40 %). Engel Class IA outcome at last follow up (mean, 10 years) was 60 %. Thirty-four patients had neuroimaging follow up of at least 1 year (mean, 5 years). AE resolved in 6, persisted in 25, evolved into bilateral HS in 1, bilateral mesial temporal atrophy in 1 and ipsilateral mesial temporal atrophy in 1. Resolution of AE was associated with better seizure free outcomes (p = 0.013). Conclusions: TLE with AE is associated with favourable prognosis yet not benign. Over 50 % were drug resistant and surgical outcomes were similar to mTLE. Resolution of AE on follow up neuroimaging was associated with better seizure free outcomes.