Morphometric MRI features and surgical outcome in patients with epilepsy related to hippocampal sclerosis and low intellectual quotient
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2018
Autores
Gaça, Larissa Botelho 
Garcia, Maria Teresa Fernandes Castilho
Sandim, Gabriel Barbosa
Noffs, Maria Helena Silva
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Objective: The objectives of this study were to verify in a series of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) if those with low intellectual quotient (IQ) levels have more extended areas of atrophy compared with those with higher IQ levels and to analyze whether IQ could be a variable implicated on a surgical outcome. Material and methods: Patients (n = 106) with refractory MTLE-HS submitted to corticoamygdalohippocampectomy (CAH) (57 left mesial temporal lobe epilepsy (MILE): 45 males) were enrolled. To determine if the IQ was a predictor of seizure outcome, totally seizure-free (SF) versus nonseizure-free (NSF) patients were evaluated. FreeSurfer was used for cortical thickness and volume estimation, comparing groups with lower (<80) and higher IQ (90-109) levels. Results: In the whole series, 42.45% of patients were SF (Engel Class la
n = 45), and 57.54% were NSF (n = 61). Total cortical volume was significantly reduced in the group with lower IQ (p = 0.01). Significant reductions in the left hemisphere included the following: rostral middle frontal (p = 0.001). insula (p = 0.002). superior temporal gyrus (p = 0.003), thalamus (p = 0.004), and precentral gyrus (p = 0.02)
and those in the right hemisphere included the following: rostra! middle frontal (p = 0.003), pars orbitalis (p = 0.01), and insula (p = 0.02). Cortical thickness analysis also showed reductions in the right superior parietal gyrus in patients with lower IQ No significant relationship between IQ and seizure outcome was found. Conclusions: This is the first study of a series of patients with pure MTLE-HS, including those with low IQ and their morphometric magnetic resonance imaging (MRI) features using FreeSurfer. Although patients with lower intellectual scores presented more areas of brain atrophy, IQ was not a predictor of surgical outcome. therefore, when evaluating seizure follow-up, low IQ in patients with MTLE-HS might not contraindicate resective surgery. (C) 2018 Elsevier Inc. All rights reserved.
n = 45), and 57.54% were NSF (n = 61). Total cortical volume was significantly reduced in the group with lower IQ (p = 0.01). Significant reductions in the left hemisphere included the following: rostral middle frontal (p = 0.001). insula (p = 0.002). superior temporal gyrus (p = 0.003), thalamus (p = 0.004), and precentral gyrus (p = 0.02)
and those in the right hemisphere included the following: rostra! middle frontal (p = 0.003), pars orbitalis (p = 0.01), and insula (p = 0.02). Cortical thickness analysis also showed reductions in the right superior parietal gyrus in patients with lower IQ No significant relationship between IQ and seizure outcome was found. Conclusions: This is the first study of a series of patients with pure MTLE-HS, including those with low IQ and their morphometric magnetic resonance imaging (MRI) features using FreeSurfer. Although patients with lower intellectual scores presented more areas of brain atrophy, IQ was not a predictor of surgical outcome. therefore, when evaluating seizure follow-up, low IQ in patients with MTLE-HS might not contraindicate resective surgery. (C) 2018 Elsevier Inc. All rights reserved.
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Epilepsy & Behavior. San Diego, v. 82, p. 144-149, 2018.