Temporal encephaloceles and coexisting epileptogenic lesions

Area of Science:

• Neurology
• Radiology
• Epileptology

Background:

• Temporal encephaloceles (TEs) are implicated in temporal lobe epilepsy.
• Identifying all coexisting structural lesions is crucial for epilepsy management.
• Standard MRI may miss subtle, epileptogenic abnormalities.

Purpose of the Study:

• To identify coexisting structural lesions in epilepsy patients with known TEs.
• To evaluate the utility of advanced postprocessing software in detecting subtle lesions.
• To assess the epileptogenic potential of TEs and associated lesions.

Main Methods:

• Retrospective review of 47 structural MRI scans from epilepsy patients with TEs.
• Visual assessment and automated postprocessing using Morphometric Analysis Program v2018 (MAP18).
• Correlation of imaging findings with clinical and electroencephalographical data.

Main Results:

• Initial MRI revealed coexisting lesions in 44.7% of patients; advanced analysis increased this to 53.2%.
• Malformations of cortical development were identified in 17.0% initially, rising to 38.3% after postprocessing.
• TEs and other lesions were considered equally epileptogenic in a significant proportion of cases.

Conclusions:

• TEs can coexist with other structural pathologies, necessitating heightened awareness in lesional epilepsy.
• The epileptogenic nature of TEs can vary, and associated lesions influence surgical evaluation.
• The association of TEs with malformations of cortical development suggests a shared developmental etiology.