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Quantitative magnetic resonance characterization of mesial temporal sclerosis in childhood
R C Scott1, D G Gadian, J H Cross
1Neurosciences Unit, Institute of Child Health, University College London, UK. rscott@ich.ucl.ac.uk
Objective:
To investigate whether quantitative MR techniques can be used to distinguish between mesial temporal sclerosis in patients with a history of prolonged febrile convulsion and in patients without such a history.
Methods:
Quantitative hippocampal T2 relaxometry, hippocampal volumetry, and single voxel (1)H-MRS data were acquired from 16 children who subsequently underwent temporal lobe resections for intractable temporal lobe epilepsy and histologically were shown to have sclerosis of the horn of Ammon. Eight children had a history of prolonged febrile convulsion in early childhood and eight children had other or no associations.
Results:
Patients with a history of prolonged febrile convulsion had smaller hippocampi (p = 0.02) and prolonged T2 relaxation time (p = 0.03) ipsilateral to the seizure focus when compared with patients without such a history. There was also more side-to-side asymmetry of T2 relaxation time (p = 0.004) and hippocampal volume (p = 0.02) in the patients with a history of prolonged febrile convulsion than in those with other or no associations. No differences between the groups were identified using (1)H-MRS.
Conclusions:
These data support the view that there are at least two types of mesial temporal sclerosis. There may be several pathogenetic pathways from initial insult to later mesial temporal sclerosis, and these pathways are, at least in part, dependent on the initial insult.
Insights
Quantitative MRI can differentiate mesial temporal sclerosis (MTS) based on early childhood febrile convulsions. Patients with a history of prolonged febrile convulsions showed distinct hippocampal volume and T2 relaxation times, suggesting different MTS subtypes.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Mesial temporal sclerosis (MTS) is a common cause of epilepsy.
- Distinguishing subtypes of MTS is crucial for understanding pathogenesis and treatment.
- The role of prolonged febrile convulsions in MTS development requires further investigation.
Purpose of the Study:
- To determine if quantitative magnetic resonance imaging (MRI) techniques can differentiate MTS in children with and without a history of prolonged febrile convulsions.
- To explore potential differences in hippocampal structure and function between these groups.
Main Methods:
- Quantitative hippocampal T2 relaxometry, hippocampal volumetry, and single voxel proton magnetic resonance spectroscopy ((1)H-MRS) were performed on 16 children with histologically confirmed MTS.
- Children were divided into two groups: eight with a history of prolonged febrile convulsions and eight with other or no associations.
- Data were analyzed to compare hippocampal characteristics between the groups.
Main Results:
- Patients with a history of prolonged febrile convulsions had significantly smaller hippocampi and prolonged T2 relaxation times ipsilateral to the seizure focus compared to the control group.
- Greater asymmetry in T2 relaxation time and hippocampal volume was observed in the prolonged febrile convulsion group.
- No significant differences were found between the groups using (1)H-MRS.
Conclusions:
- The findings suggest at least two distinct types of mesial temporal sclerosis.
- The results support the hypothesis that different initial insults may lead to distinct pathogenetic pathways in the development of MTS.
- Quantitative MRI can aid in differentiating MTS subtypes, potentially informing prognosis and therapeutic strategies.