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Temporal lobe epilepsy with amygdala enlargement: A systematic review
Kamalesh Chakravarty1, Sucharita Ray1, Parampreet S Kharbanda1
1Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Acta Neurologica Scandinavica
|May 14, 2021
Summary
Temporal lobe epilepsy with amygdala enlargement (AE) presents differently than hippocampal sclerosis (HS). This analysis highlights AE
Area of Science:
- Neurology and Neurosurgery
- Epileptology
- Clinical Neuroscience
Background:
- Temporal lobe epilepsy (TLE) is a common neurological disorder.
- TLE with amygdala enlargement (AE) is a distinct subtype with unique clinical features compared to TLE with hippocampal sclerosis (HS).
- Understanding the characteristics and treatment outcomes of TLE with AE is crucial for patient management.
Purpose of the Study:
- To systematically analyze the clinical characteristics of patients with TLE and AE.
- To evaluate the treatment outcomes for TLE with AE.
- To explore potential etiologies, including autoimmune factors, for AE in TLE.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Cochrane, Web of Science, Scopus, Medline) in November 2020.
- Keywords included 'amygdala enlargement', 'temporal lobe epilepsy', 'epilepsy', and 'seizure'.
- 18 studies comprising 361 patients with TLE and AE were included in the analysis.
Main Results:
- The mean age of onset for TLE with AE was 36.2 years; febrile seizures were less common than in TLE with HS.
- Electroencephalography (EEG) findings were generally concordant with the side of AE.
- Of 86 surgically treated patients, 69.7% achieved an Engel I outcome. Histopathology revealed predominantly dysplasia and gliosis. Some patients showed positive response to immunotherapy, suggesting a potential autoimmune etiology.
Conclusions:
- TLE with AE represents a distinct clinical entity with specific characteristics and treatment responses.
- Evidence suggests potential developmental anomalies or autoimmune processes as underlying etiologies for AE.
- Heterogeneity in study methodologies and amygdala volume measurement poses challenges for direct comparison and highlights the need for standardization.
