Diagnosis and surgical treatment of non-lesional temporal lobe epilepsy with unilateral amygdala enlargement
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ORIGINAL ARTICLE
Diagnosis and surgical treatment of non-lesional temporal lobe epilepsy with unilateral amygdala enlargement Zhen Fan 1 & Bing Sun 1 & Li-qin Lang 1 & Jie Hu 1 & N. U. Farrukh Hameed 1 & Zi-xuan Wei 1 & Qi-yuan Zhuang 1 & Jia-jun Cai 1 & Feng-tao Liu 2 & Yi-ting Mao 2 & Rui Feng 1 & Li Pan 1 Received: 1 July 2020 / Accepted: 3 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Objective Exploring the role of amygdala enlargement (AE) in temporal lobe epilepsy (TLE) without ipsilateral mesial temporal sclerosis (MTS) using comprehensive presurgical workup tools including traditional tools, automatically volumetric analysis, high-density EEG (HD-EEG) source imaging (HD-ESI), and stereoelectroencephalography (SEEG). Methods Nine patients diagnosed with TLE-AE who underwent resective surgeries encompassing the amygdala were retrospectively studied. HD-ESI was obtained using 256-channel HD-EEG on the individualized head model. For automatic volumetric analysis, 48 matched controls were enrolled. Diagnosis and surgical strategies were based on a comprehensive workup following the anatomo-electro-clinical principle. Results At post-operative follow-up (average 30.9 months), eight patients had achieved Engel class I and one Engel class II recovery. HD-ESI yielded unifocal source estimates in anterior mesial temporal region in 85.7% of cases. Automatic volumetric analysis showed the AE sides were consistent with the values determined through other preoperative workup tools. Furthermore, the amygdala volume of the affected sides in AE was significantly greater than that of the larger sides in controls (p < 0.001). Meanwhile, the amygdala volume lateral index (LI) of AE was significantly higher than in controls (p < 0.001). SEEG analysis showed that ictal onsets arose from the enlarged amygdala (and hippocampus) in all cases. Conclusion In addition to traditional workup tools, automatic volumetric analysis, HD-ESI on individualized head model, and invasive SEEG can provide evidence of epileptogenicity in TLE-AE. Resective surgical strategies encompassing the amygdala result in better prognosis. In suspected TLE cases, more attention should be focused on detecting enlargement of amygdala which sometimes is “hidden” in “MR-negative” non-MTS cases. Keywords Amygdala enlargement . Temporal lobe epilepsy . Resective surgery . Automatically volumetric analysis . EEG source imaging
Abbreviations TLE-AE temporal lobe epilepsy with unilateral Amygdala Enlargement Zhen Fan and Bing Sun contributed equally to this work. * Jie Hu [email protected]
ATL HD-ESI LI MTS NC sAH SEEG
Anterior temporal lobectomy High-density electroencephalographic source imaging Lateral index Mesial temporal sclerosis Normal control Selective amygdalohippocampectomy Stereo-electroencephalography
* Rui Feng [email protected]; [email protected] 1
Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Mid Wulumuqi Rd, Shanghai 200040, China
2
Department of Neurology, Hu
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