Riassunto analitico
Epilepsy affects between 0.6% and 1.5% of the global population. Among the different epileptic syndromes, Temporal Lobe Epilepsy (TLE) is the most prevalent form of focal epilepsy. The most common histopathologic abnormality in adults with TLE is hippocampal sclerosis (TLE-HS). However, up to 30% of TLE cases show no detectable lesions at the MRI, these patients are classified as TLE with a negative MRI (TLE-MRIneg). Understanding the clinical and morphometric differences between these two TLE subtypes can enhance diagnosis and treatment strategies.
A multicenter study was conducted across multiple hospitals in Italy, involving 115 patients with TLE who underwent structural MRI between 2015 and 2021. Inclusion criteria were (i) a clinical diagnosis of TLE and (ii) a brain MRI protocol including a high-resolution 3D T1-weighted sequence. Exclusion criteria included (i) structural abnormalities other than HS, (ii) progressive diseases, and (iii) previous neurosurgery. Patients were classified as TLE-HS or TLE-MRIneg based on MRI findings, with 52 patients in the TLE-HS group and 63 in the TLE-MRIneg group. Clinical data were collected, including demographic information, seizure characteristics, and treatment history. MRI data from 142 healthy controls were also included for comparison.
The study revealed significant clinical differences between TLE-HS and TLE-MRIneg patients. TLE-HS patients exhibited earlier seizure onset, longer disease duration, and higher seizure frequency. Additionally, TLE-HS patients were associated with more frequent febrile convulsions, loss of consciousness, and drug resistance. Morphometric analysis showed decreased hippocampal volume ipsilateral to the epileptic focus in TLE-HS patients, with specific atrophy in hippocampal subfields and thalamic complexes. TLE-MRIneg patients did not exhibit significant structural differences compared to healthy controls. Correlation analyses were performed to investigate the relationships between age at MRI, age of onset, and disease duration with subcortical volumes in the TLE, TLE-HS and TLE-MRIneg groups. While overarching similarities exist in how subcortical volumes correlate with age of onset, disease duration, and age at MRI, each group exhibits unique correlation patterns, reflecting underlying differences in pathology and disease progression among TLE subtypes.
The study highlights significant clinical and morphometric differences between TLE-HS and TLE-MRIneg patients, suggesting different underlying pathophysiological mechanisms. These findings emphasize the importance of personalized treatment approaches and the potential of advanced imaging techniques to better characterize TLE-MRIneg. Future research should focus on longitudinal studies to further elucidate the pathophysiological mechanisms behind TLE subtypes and improve patient outcomes.
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