Relationship between environmental factors and gray matter atrophy in refractory MTLE

• Published in: Neurology Vol. 74; no. 13; pp. 1062 - 1068
• Main Authors: YASUDA, C. L, MORITA, M. E, GUERREIRO, C. A. M, DAMASCENO, B. P, LOPES-CENDES, I, TEDESCHI, H, DE OLIVEIRA, E, CENDES, F, ALESSIO, A, PEREIRA, A. R, BALTHAZAR, M. L. F, SAUDE, A. V, COSTA, A. L. F, COSTA, A. L. C, CARDOSO, T. A, BETTING, L. E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 30-03-2010
• Subjects: Adult; Biological and medical sciences; Brain - pathology; Brain - surgery; Cohort Studies; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Environment; Epilepsy, Temporal Lobe - etiology; Epilepsy, Temporal Lobe - pathology; Epilepsy, Temporal Lobe - surgery; Family; Female; Functional Laterality; Humans; Intelligence Tests; Magnetic Resonance Imaging; Male; Medical sciences; Nerve Fibers, Myelinated - pathology; Nerve Fibers, Unmyelinated - pathology; Neurology; Neuropsychological Tests; Organ Size; Atrophy; Refractory; Environmental factor; Nervous system diseases
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e3181d76b72

To investigate clinical, neuropsychological, and MRI abnormalities (gray matter atrophy [GMA] and white matter atrophy [WMA]) in surgical mesial temporal lobe epilepsy (MTLE) patients with and without familial antecedent for epilepsy.
A cohort study including 69 operated patients with unilateral MTLE, divided into a group of 29 patients (mean age 35.8 +/- 10.4 years) with a negative family history (FH) of epilepsy and a group of 40 patients (32.8 +/- 10 years) with a positive FH. We performed voxel-based morphometry (VBM) on preoperative MRIs and investigated possible clinical and neuropsychological differences between the 2 groups. We also performed VBM and t tests to compare the patients' groups with normal controls.
The negative-FH group had lower IQ scores (p = 0.004), performed poorer on the Boston Naming Test (p = 0.02) and on delayed recall (p = 0.03), and presented a more prominent asymmetry index of hippocampal volume (p = 0.04) and more frequent initial precipitating injuries (p = 0.023). VBM showed a more restricted pattern of GMA in the positive-FH group and a more bilateral and widespread pattern of GMA in the negative-FH group, involving thalami, temporal, frontal, parietal, and occipital lobes. WMA was widespread and bilateral in both groups.
The more widespread structural voxel-based morphometry abnormalities and worse IQ performance identified in the negative-family history (FH) group may result from a stronger environmental influence, including initial precipitating injuries. This is further support for the hypothesis that hippocampal sclerosis in mesial temporal lobe epilepsy with positive FH is determined by a stronger genetic predisposition with less influence of environmental factors compared with patients in the negative-FH group.