Major Depression in Temporal Lobe Epilepsy with Hippocampal Sclerosis: Clinical and Imaging Correlates. Briellmann RS, Hopwood MJ, Jackson GD. J Neurol Neurosurg Psychiatry 2007 Jan 26; [Epub ahead of print] PURPOSE: Refractory temporal lobe epilepsy (TLE) is often associated with hippocampal sclerosis (HS). Patients with Major Depression (MD) may also show structural abnormalities in the limbic system. Co-occurrence of TLE with HS and MD is not uncommon. We investigate clinical and morphological characteristics of TLE patients in relation to MD. METHODS: Thirty-four TLE patients with HS were assessed at a Comprehensive Epilepsy Program. All relevant clinical data were obtained, including the history of antecedent events to epilepsy. MD was diagnosed based on detailed psychiatric investigation. MRI was used to measure the volume and tissue signal (T2-relaxometry) of the hippocampus and amygdala. The imaging data were expressed as percentage of the values obtained in a series of 55 controls. RESULTS: A history of MD was present in 15 (44%) of the 34 patients. Patients with MD had a longer duration of their epilepsy ( p < 0.05), and a lower frequency of antecedent events (13% with MD, 58% without MD, p < 0.05). Both groups had a similar degree of ipsilateral HS (small hippocampal volume, increased hippocampal T2-relaxation time), and demonstrated bilateral amygdaloid atrophy. However, the contralateral amygdala showed lower signal in presence of MD (97 ± 9 msec; no MD: 103 ± 8 msec, ANCOVA, p < 0.05). CONCLUSION: The integrity of the amygdala may influence mood disturbances in TLE patients with HS, as depression was associated with a relative preservation of the contralateral amygdala. In contrast, hippocampal abnormalities were not related to the presence of depression. Hippocampal 1H-MRSI Correlates with Severity of Depression Symptoms in Temporal Lobe Epilepsy. Gilliam FG, Maton BM, Martin RC, Sawrie SM, Faught RE, Hugg JW, Viikinsalo M, Kuzniecky RI. Neurology 2007;68(5):364–368. OBJECTIVE: To investigate the association of an indicator of hippocampal function with severity of depression symptoms in temporal lobe epilepsy. METHODS: We evaluated 31 patients with video/EEG-confirmed temporal lobe epilepsy using creatine/ N-acetylaspartate ratio maps derived from a previously validated 1H magnetic resonance spectroscopic imaging (1H-MRSI) technique at 4.1 T. We also assessed depression symptoms, epilepsy-related factors, and self-perceived social and vocational disability. We used conservative nonparametric bivariate procedures to determine the correlation of severity of depression symptoms with imaging and clinical variables. RESULTS: The extent of hippocampal 1H-MRSI abnormalities correlated with severity of depression (Spearman rho = 0.65, p value < 0.001), but other clinical factors did not. CONCLUSION: The extent of hippocampal dysfunction is associated with depression symptoms in temporal lobe epilepsy and may be a more important factor than seizure frequency or degree of disability.
Comparison of short-term outcome between surgical and clinical treatment in temporal lobe epilepsy: A prospective study