Epileptogenic networks in drug-resistant epilepsy with amygdala enlargement: Assessment with stereo-EEG and 7 T MRI. (January 2022)

• Record Type: Journal Article
• Authors: Makhalova, Julia; Le Troter, Arnaud; Aubert-Conil, Sandrine; Giusiano, Bernard; McGonigal, Aileen; Trebuchon, Agnès; Carron, Romain; Medina Villalon, Samuel; Bénar, Christian G.; Ranjeva, Jean-Philippe; Guye, Maxime; Bartolomei, Fabrice
• Is Part Of: Clinical neurophysiology. Volume 133(2022)
• Page Start: 94
• Page End: 103
• Publication Date: 2022-01
• Subjects: Amygdala morphometry -- Connectivity Epileptogenicity Index -- Limbic network -- Pharmacoresistant epilepsy -- Seizure onset zone -- Ultra-high-field MRI; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2021.10.012
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Drug-resistant focal epilepsy with amygdala enlargement is heterogeneous in terms of epileptogenicity. Seizure-onset zone involves distributed epileptogenic networks and corresponds to "temporal plus" epilepsies in most cases. The extent of amygdala enlargement positively correlated with the level of depression defined by clinical scores. Abstract: Objective: Amygdala enlargement is increasingly described in association with temporal lobe epilepsies. Its significance, however, remains uncertain both in terms of etiology and its link with psychiatric disorders and of its involvement in the epileptogenic zone. We assessed the epileptogenic networks underlying drug-resistant epilepsy with amygdala enlargement and investigated correlations between clinical features, epileptogenicity and morphovolumetric amygdala characteristics. Methods: We identified 12 consecutive patients suffering from drug-resistant epilepsy with visually suspected amygdala enlargement and available stereoelectroencephalographic recording. The epileptogenic zone was defined using the Connectivity Epileptogenicity Index. Morphovolumetric measurements were performed using automatic segmentation and co-registration on the 7TAMIbrain Amygdala atlas. Results: The epileptogenic zone involved the enlarged amygdala in all but three cases and corresponded to distributed, temporal-insular, temporal-insular-prefrontal or prefrontal-temporal networks in ten cases, while only two were temporo-mesial networks. Morphovolumetrically, amygdala enlargement was bilateral in 75% of patients. Most patients presented psychiatric comorbidities (anxiety, depression, posttraumatic stress disorder). The level of depression defined by screening questionnaire was positively correlated with the extent of amygdala enlargement. Conclusions: Drug-resistant epilepsy with amygdala enlargement is heterogeneous; most cases implied "temporal plus" networks. Significance: The enlarged amygdala could reflect an interaction of stress-mediated limbic network alterations and mechanisms of epileptogenesis.