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Related Experiment Videos

Olfactory bedside test. A simple approach to identify temporo-orbitofrontal dysfunction

I Savic1, S Y Bookheimer, I Fried

  • 1Department of Neurology, University of California, Los Angeles, USA.

Archives of Neurology
|February 1, 1997
PubMed
Summary
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Olfactory tests can identify mesial temporal lobe epilepsy (MTLS) by detecting impairments in olfactory discrimination and memory. These olfactory deficits, linked to specific brain regions, help differentiate MTLS from neocortical seizures.

Area of Science:

  • Neuroscience
  • Epilepsy Research
  • Olfactory Function

Background:

  • Olfactory memory and discrimination rely on the anteromesial temporal cortex and orbitofrontal cortex.
  • Limbic epilepsy, specifically mesial temporal lobe epilepsy (MTLS), may impair these olfactory functions due to shared neural pathways.

Purpose of the Study:

  • To evaluate olfactory quality discrimination (OD) and delayed recognition memory (OM) in patients with MTLS and neocortical seizures (NS).
  • To determine if olfactory test performance correlates with regional glucose metabolism measured by F-18 positron emission tomography (PET).
  • To assess the utility of olfactory tests in differentiating between MTLS and NS.

Main Methods:

  • Twenty-seven MTLS patients, 10 NS patients, and 10 controls underwent standardized olfactory tests (OD and OM) using the University of Pennsylvania Smell Identification Test.

Related Experiment Videos

  • Olfactory test performance was correlated with regional glucose metabolism assessed via F-18 PET scans.
  • Tests involved same-different paradigms with varying inter-stimulus intervals (10 seconds for OD, 60 minutes for OM).

    • Main Results:

    • Patients with MTLS showed significantly impaired OD ipsilateral to the seizure focus and a higher total error count across both tests.
    • While OM scores were lower in MTLS patients, the difference was not statistically significant compared to NS patients.
    • Combined OD and OM tests achieved 85% sensitivity and 90% specificity in identifying MTLS, with 74% correct lateralization.
    • MTLS patients with greater OD impairment than OM impairment exhibited hypometabolism in the ipsilateral temporal neocortex, anterior temporal cortex, and orbitofrontal cortex.

    Conclusions:

    • Olfactory function tests are valuable tools for distinguishing between neocortical seizures and mesial temporal lobe epilepsy.
    • Impairments in olfactory memory and discrimination can be dissociated, suggesting they are mediated by distinct neural structures.
    • Olfactory testing, combined with neuroimaging, aids in presurgical evaluation and lateralization of epilepsy.