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Incomplete hippocampal inversion: diagnostic criteria and effect on epilepsy, seizure localization and therapeutic
André Vaz1, Bernardo Corrêa de Almeida Teixeira2, Debora Brighente Bertholdo3
1Hospital Pequeno Príncipe (Curitiba, Brazil), and Universidade Federal do Paraná (Curitiba, Brazil). Postal address: Centro de Imagem (CEIMA), Rua Desembargador Motta, 1070, 80250-060 Curitiba, Brazil.
Insights
A new Magnetic Resonance Imaging (MRI) score helps identify Incomplete Hippocampal Inversion (IHI) in children. This finding is linked to epilepsy, particularly temporal lobe epilepsy, and may predict treatment response.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Epileptology
Background:
- Incomplete Hippocampal Inversion (IHI) is a developmental variation observed in the hippocampus.
- Understanding the clinical significance of IHI in pediatric populations is crucial for diagnosis and management.
Purpose of the Study:
- To develop a simple Magnetic Resonance Imaging (MRI)-based score for defining Incomplete Hippocampal Inversion (IHI) in children.
- To investigate the association of IHI with epilepsy, seizure localization, and treatment outcomes in pediatric patients.
Main Methods:
- Phase 1: Developed an MRI-based score using qualitative and quantitative hippocampal features on T1W and T2W images to define IHI.
- Phase 2: Applied the developed scores to a cohort of pediatric epilepsy patients and matched controls to assess associations.
Main Results:
- The developed MRI scores demonstrated high accuracy in identifying IHI (AUCs of 0.965 for T1W and 0.983 for T2W).
- IHI was independently associated with an increased risk of epilepsy (OR=3.144), temporal lobe epilepsy (OR=4.237), and drug-resistant epilepsy (OR=7.000).
Conclusions:
- The findings suggest a potential link between IHI and the pathophysiology of temporal lobe epilepsy.
- IHI may serve as a prognostic marker for therapeutic response in pediatric epilepsy patients.
Purpose:
Elaborate a simple Magnetic Resonance Imaging (MRI)-based score to define Incomplete Hippocampal Inversion (IHI) in children (Phase 1), and evaluate the relation of IHI with (A) epilepsy, (B) seizure localization and (C) therapeutic response in a paediatric population (Phase 2).
Methods:
In Phase 1, incompletely inverted hippocampi were matched to completely inverted hippocampi. Multiple qualitative and quantitative hippocampal and extra-hippocampal features were evaluated in coronal-oblique T1-weighted (T1W) and coronal T2-weighted (T2W) images. Multivariate analysis was performed to elaborate the MRI-based score to define IHI. In Phase 2, epilepsy patients were matched to controls, and the T1W and T2W scores were applied. Multivariate analysis was performed to assess the relation of IHI and epilepsy, seizure localization and therapeutic response.
Results:
The hippocampal diameter ratio and parahippocampal angle in the coronal-oblique T1-weighted images, and the hippocampal diameter ratio and collateral sulcus depth in the coronal T2-weighted images predicted IHI in Phase 1. Simple and practical imaging-based scores were developed and are available on the website: https://ihiscore.netlify.app/. The Area Under the Receiver Operating Characteristic Curve of the T1W and T2W scores were, respectively, 0.965 and 0.983. In Phase 2, IHI independently predicted epilepsy (OR = 3.144, 95% CI = 1.981-4.991, p < 0.001), temporal lobe epilepsy (OR = 4.237, 95% CI = 1.586-11.318, p = 0.004), and drug resistant epilepsy (OR = 7.000, 95% CI = 2.800-17.500, p < 0.001).
Conclusion:
The association between IHI and temporal lobe epilepsy (and the lack of association with extra-temporal epilepsy) favours the possibility of a relation between IHI and the pathophysiology of seizures in epileptic patients. Furthermore, IHI is a potential prognostic marker for therapeutic response in epilepsy.
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