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Relationship between environmental factors and gray matter atrophy in refractory MTLE

2010; Lippincott Williams & Wilkins; Volume: 74; Issue: 13 Linguagem: Inglês

10.1212/wnl.0b013e3181d76b72

1526-632X

Clarissa Lin Yasuda, Márcia Elizabete Morita, Andréa Alessio, Amanda Pereira, Márcio Luiz Figueredo Balthazar, André Vital Saúde, André Luiz Ferreira Costa, Alberto Costa, Tânia Aparecida Marchiori de Oliveira Cardoso, Luiz Eduardo Betting, Carlos A.M. Guerreiro, Benito Pereira Damasceno, Íscia Lopes‐Cendes, Hélder Tedeschi, Evandro de Oliveira, Fernando Cendes,

Genetics and Neurodevelopmental Disorders

Objective: To investigate clinical, neuropsychological, and MRI abnormalities (gray matter atrophy [GMA] and white matter atrophy [WMA]) in surgical mesial temporal lobe epilepsy (MTLE) patients with and without familial antecedent for epilepsy. Methods: A cohort study including 69 operated patients with unilateral MTLE, divided into a group of 29 patients (mean age 35.8 ± 10.4 years) with a negative family history (FH) of epilepsy and a group of 40 patients (32.8 ± 10 years) with a positive FH. We performed voxel-based morphometry (VBM) on preoperative MRIs and investigated possible clinical and neuropsychological differences between the 2 groups. We also performed VBM and t tests to compare the patients9 groups with normal controls. Results: The negative-FH group had lower IQ scores ( p = 0.004), performed poorer on the Boston Naming Test ( p = 0.02) and on delayed recall ( p = 0.03), and presented a more prominent asymmetry index of hippocampal volume ( p = 0.04) and more frequent initial precipitating injuries ( p = 0.023). VBM showed a more restricted pattern of GMA in the positive-FH group and a more bilateral and widespread pattern of GMA in the negative-FH group, involving thalami, temporal, frontal, parietal, and occipital lobes. WMA was widespread and bilateral in both groups. Conclusions: The more widespread structural voxel-based morphometry abnormalities and worse IQ performance identified in the negative–family history (FH) group may result from a stronger environmental influence, including initial precipitating injuries. This is further support for the hypothesis that hippocampal sclerosis in mesial temporal lobe epilepsy with positive FH is determined by a stronger genetic predisposition with less influence of environmental factors compared with patients in the negative-FH group.