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Temporal encephaloceles and coexisting epileptogenic lesions

Objective: This study was performed to identify coexisting structural lesions in patients with epilepsy and known temporal encephaloceles (TEs).Methods: Forty- seven structural magnetic resonance imaging (MRI) scans of patients with epilepsy and radiologically diagnosed TEs were ret...

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Main Authors: Tsalouchidou, Panagiota-Eleni, Zoellner, Johann Philipp, Kirscht, Annika, Mueller, Christina Julia, Nimsky, Christopher, Schulze, Maximilian, Hattingen, Elke, Chatzis, Georgios, Freiman, Thomas M., Strzelczyk, Adam, Fuest, Sven, Menzler, Katja, Rosenow, Felix, Knake, Susanne
Format: Article
Language:English
Published: Philipps-Universität Marburg 2023
Subjects:
epilepsy surgery
temporal encephaloceles, temporal lobe epilepsy
focal cortical dysplasia
Medizin
structural epilepsy
Medical sciences Medicine
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Summary:Objective: This study was performed to identify coexisting structural lesions in patients with epilepsy and known temporal encephaloceles (TEs).Methods: Forty- seven structural magnetic resonance imaging (MRI) scans of patients with epilepsy and radiologically diagnosed TEs were retrospec-tively reviewed visually and using an automated postprocessing software, the Morphometric Analysis Program v2018 (MAP18), to depict additional subtle, potentially epileptogenic lesions in the 3D T1- weighted MRI data. All imaging findings were evaluated in the context of clinical and electroencephalographical findings.Results: The study population consisted of 47 epilepsy patients (38.3% female, n = 18). The median age at the time of the scan was 40 years (range 12– 81 years). Twenty- one out of 47 MRI scans (44.7%) showed coexisting lesions in the initial MRI evaluation; in 38.3% (n = 18) of patients, those lesions were considered probably epileptogenic. After postprocessing, probable epileptogenic lesions were identified in 53.2% (n = 25) of patients. Malformations of cortical develop-ment had initially been reported in 17.0% (n = 8) of patients with TEs, which increased to 38.3% (n = 18) after postprocessing. TEs and other epileptogenic le-sions were considered equally epileptogenic in 21.3% (n = 10) of the cases in the initial MR reports and 25.5% (n = 12) of the cases after postprocessing.Significance: Temporal encephaloceles are a potential cause of MRI- negative temporal lobe epilepsy. According to our data, TEs can occur with other lesions, suggesting that increased awareness is also required in patients with lesional epi-lepsy. TEs may not always be epileptogenic; hence, their occurrence with other structural pathologies may influence the presurgical evaluation and surgical ap-proach. Finally, TEs can be associated with malformations of cortical develop-ment, which may indicate a common developmental etiology of those lesions.
DOI:10.1002/epi4.12674

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