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Amygdala enlargement in mesial temporal lobe epilepsy: an alternative imaging presentation of limbic epilepsy

  • Diagnostic Neuroradiology
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Abstract

Purpose

To assess imaging, clinical, and pathological features of mesial temporal lobe epilepsy (mTLE) patients with amygdala enlargement (AE) in comparison with those with mesial temporal sclerosis (MTS).

Methods

Clinical, imaging, and pathologic features were retrospectively reviewed in 40 mTLE patients with postoperative follow-up (10 with AE and 30 with MTS). The volumes and signal intensity of the amygdala and hippocampus were assessed in 10 AE, 10 age- and sex-matched MTS patients, and 12 controls (HC).

Results

AE patients had a lower rate of concordant FDG PET (p < 0.05) and required more frequently intracerebral electrodes compared to MTS patients (p < 0.05). AE had larger ipsilateral amygdala (p < 0.0001) and hippocampus volumes (p < 0.0001) compared to MTS and to HC, with no significant differences for other brain structures. Normalized FLAIR signal was higher in the ipsilateral than contralateral amygdala in both AE and MTS (p < 0.001 and p < 0.05, respectively) and higher in the ipsilateral amygdala compared to HC (p < 0.05). In MTS, ADC in the ipsilateral amygdala (867 mm2/s) was higher compared to the contralateral one (804.8 × 10–6 mm2/s, p < 0.01), compared to HC (773 × 10–6 mm2/s, p < 0.01) and compared to the ipsilateral amygdala in AE (813.7 × 10–6 mm2/s, p < 0.05). AE patients had dysplasia (50%) or astrocytic gliosis (50%) of the amygdala extending to the hippocampus and temporal isocortex, and only 2/10 cases had pathologic findings of MTS.

Conclusion

AE patients have distinct imaging and pathologic features compared to MTS, and require more extensive preoperative workup. Recognition of AE may improve preoperative assessment in TLE surgical candidates.

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Authors and Affiliations

  1. Department of Radiology, Division of Neuroradiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Aristides A. Capizzano

  2. Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA

    Hiroto Kawasaki

  3. Department of Neurology, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA

    Rup K. Sainju

  4. Department of Pathology, University of Iowa Carver College of Medicine, 200 Hawkins Dr., Iowa City, IA, 52242, USA

    Patricia Kirby

  5. Department of Radiology, University of Michigan, 1500 East Medical Center Drive, 200 Hawkins Dr., Ann Arbor, MI, 48109, USA

    John Kim & Toshio Moritani

Authors
  1. Aristides A. Capizzano
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  2. Hiroto Kawasaki
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  3. Rup K. Sainju
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  4. Patricia Kirby
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  5. John Kim
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  6. Toshio Moritani
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Correspondence to Aristides A. Capizzano.

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No funding was received for this study.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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For this type of retrospective study formal consent is not required.

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Capizzano, A.A., Kawasaki, H., Sainju, R.K. et al. Amygdala enlargement in mesial temporal lobe epilepsy: an alternative imaging presentation of limbic epilepsy. Neuroradiology 61, 119–127 (2019). https://doi.org/10.1007/s00234-018-2109-y

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  • DOI: https://doi.org/10.1007/s00234-018-2109-y

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