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Rethinking cortical hypertrophy in temporal lobe epilepsy.

Hélène Cossette-Roberge¹, Binh Thanh Nguyen², Fatemeh Fadaie³

¹Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada.

Brain : a Journal of Neurology

|June 22, 2026

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This summary is machine-generated.

Temporal lobe epilepsy (TLE) involves brain changes beyond just atrophy. This review explores cortical hypertrophy in TLE, suggesting a more complex remodeling process in this common neurological disorder.

Area of Science:

Neurology
Neuroimaging
Epilepsy Research

Background:

Temporal lobe epilepsy (TLE) is the most common adult focal epilepsy.
Traditionally, TLE is characterized by hippocampal and extra-hippocampal atrophy.
Emerging evidence suggests cortical hypertrophy (increased thickness) also occurs in TLE.

Purpose of the Study:

To synthesize evidence for cortical hypertrophy in TLE.
To explore potential neurobiological mechanisms underlying cortical hypertrophy.
To discuss the implications for understanding TLE as a brain remodeling disorder.

Main Methods:

Narrative review of existing literature.
Overview of magnetic resonance imaging (MRI) methods for measuring cortical thickness (surface-based, volume-based, voxel-based).

Keywords:

cortical thickness hypertrophy morphometry structural MRI temporal lobe epilepsy

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Synthesis of MRI studies reporting cortical hypertrophy in TLE.

Main Results:

Multiple studies report cortical hypertrophy in TLE, challenging unidirectional atrophy models.
Variability exists in reported affected regions, patient cohorts, and analytical techniques.
Potential mechanisms include seizure-related remodeling, glial/inflammatory processes, and neuroplasticity.

Conclusions:

Cortical hypertrophy is a recognized phenomenon in TLE.
Understanding both atrophy and hypertrophy is crucial for a comprehensive view of TLE.
Further research is needed on the biological validity, dynamics, and clinical relevance of cortical hypertrophy in TLE.