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Late drug-resistance in mild MTLE: Can it be influenced by preexisting white matter alterations?
- Source :
- EpilepsiaREFERENCES. 61(5)
- Publication Year :
- 2020
-
Abstract
- Objective To identify early structural alterations preceding the development of drug-resistance in mild mesial temporal lobe epilepsy (mMTLE), a drug-responsive syndrome ideal for investigating epilepsy pathophysiology and potential prognostic markers of long-term clinical outcome, using magnetic resonance imaging (MRI) at baseline and after 12-year follow-up. Methods Since 2002, a total of 55 participants with a baseline diagnosis of mMTLE underwent three-dimensional (3D) T1 1.5T MRI. Based on long-term outcome (follow-up 12 ± 3 years), we identified 39 patients with stable mMTLE (smMTLE) and 16 patients who had developed drug-resistance overtime (refractory MTLE [rMTLE]). At follow-up, 21 smMTLE and 13 rMTLE patients underwent 3T-MRI including diffusion-weighted scans. Structural images were processed using longitudinal voxel-based morphometry and standard Freesurfer analysis. Statistical analyses were carried out accounting for age, age at onset, gender, hippocampal volume, and hippocampal sclerosis (Hs). Results Patients presented similar demographic, clinical, and Hs features. White matter volume of the arcuate fasciculi, corticospinal tracts, left retrosplenial cingulum, and left inferior longitudinal fasciculus was reduced only in rMTLE patients before the development of drug-resistance. At follow-up, rMTLE showed decreased fractional anisotropy in the corpus callosum, superior longitudinal fasciculi, and major bundles of the right hemisphere. Significance White matter temporal and extratemporal abnormalities are preexisting in patients with mild MTLE who will develop drug-resistance, independently from the presence of Hs. Thus, these changes might be due to an inherited genetic alteration rather than a subordinate worsening after repeated seizures, multiple antiepileptic drugs, or initial precipitating factors.
- Subjects :
- 0301 basic medicine
Adult
Male
medicine.medical_specialty
Drug Resistant Epilepsy
Drug Resistance
Neuroimaging
Corpus callosum
computer.software_genre
Hippocampus
White matter
03 medical and health sciences
Epilepsy
0302 clinical medicine
Voxel
Internal medicine
Fractional anisotropy
medicine
Cingulum (brain)
Humans
Hippocampal sclerosis
medicine.diagnostic_test
business.industry
Brain
Magnetic resonance imaging
medicine.disease
Magnetic Resonance Imaging
White Matter
030104 developmental biology
medicine.anatomical_structure
Diffusion Magnetic Resonance Imaging
Neurology
Epilepsy, Temporal Lobe
Cardiology
Anticonvulsants
Female
Neurology (clinical)
business
computer
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15281167
- Volume :
- 61
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- EpilepsiaREFERENCES
- Accession number :
- edsair.doi.dedup.....dbee2a12ba1c919918940ec5aef58c55