Figures
Figure 1
Fusion MRI and post-implantation CT. (A) Axial fluid-attenuated inversion recovery (FLAIR) shows the deepest contact (yellow circle) of the depth electrode in the enlarged amygdala (Case 3). (B) Axial FLAIR shows three consecutive contacts (yellow circles) of the depth electrode towards the enlarged amygdala (Case 3). (C) 3D-MRI shows the mesial temporal strip (T shape) that covers the hippocampus, the uncal strip, and a part of the grid that covers the lateral temporal region (Case 4).
Figure 1
Figure 2
The enlarged amygdala and MRI-negative hippocampus (Case 6). (A) Axial fluid-attenuated inversion recovery (FLAIR) shows the left enlarged amygdala with slightly increased intensity (white arrow). (B) Axial FLAIR shows normal bilateral hippocampi.
Figure 2
Figure 3
Comparison of amygdala and hippocampus volumes in patients with TLE-AE (epileptic side and non-epileptic side) and normal controls. Boxes signify the upper and lower quartiles of amygdala and hippocampus volumes. The black line within each box marks the median. The “x” in each box represents the mean. The whiskers extending above and below each box represent the largest and smallest data element; 1.5 times the interquartile range (IQR). Open circles demonstrate values outside this range. *p <0.05, **p <0.01. The amygdala volumes on the epileptic side were significantly larger than those on the non-epileptic side in patients with TLE-AE (p <0.01). The amygdala volumes on the epileptic side were significantly larger than those of the normal controls (p <0.01). The hippocampus volumes on the epileptic side were larger than those on the non-epileptic side in patients with TLE-AE (p <0.05). The hippocampus volumes on the epileptic side of patients with TLE-AE had no atrophic signs compared to those of the normal controls.
Figure 3
Figure 4
Intracranial video-EEG at the time of seizure onset (Case 6). Referential montage using an epidural electrode for reference. Blue: four amygdala depth electrodes (top) and three uncal strip electrodes (bottom). Red: four hippocampal electrodes (top) and three subtemporal electrodes (bottom) of the T-shape strip. Prior to seizure onset, high-amplitude rhythmic spike and slow waves are seen synchronously over the amygdala, uncus, and hippocampus. Paroxysmal low-amplitude fast activities started in the amygdala, uncus, and hippocampus at the seizure onset, with following evolution of amplitude and frequency. Two contacts (one from the uncal strip and the other from the subtemporal electrode) were eliminated due to artefacts.
Figure 4
Figure 5
Pre- and post-operative memory functions of verbal, visual, and general memory, and attention/concentration and delayed recall (WMSR). The horizontal line inside each box indicates the median, and the length of each box indicates the interquartile range (IQR). The extremities of the whiskers indicate the data within 1.5 IQR from the upper or lower quartile. The open circles indicate outliers. The diamond plots indicate the mean score of memory functions before and after surgery (six months, and between 12 and 24 months). There is no significant difference between any of the pre- or post-operative memory functions.
Figure 5
Tables
Authors
1 Department of Neurosurgery, The Juntendo University, Tokyo, Japan
2 Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
3 Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
* Correspondence: Hidenori Sugano
Division of Neurosurgery,
The Juntendo University,
2-1-1 Hongo, Bunkyo-ku,
Tokyo, 113-8421, Japan
Aims Temporal lobe epilepsy with amygdala enlargement (TLE-AE) has been considered a subtype of TLE. We evaluated the epileptogenic zone in patients with TLE-AE, who underwent intracranial video-EEG (ivEEG) and/or intraoperative electrocorticography (ioECoG) as well as epilepsy surgery.