Clinical patterns of patients with temporal lobe epilepsy and pure amygdalar atrophy

Purpose: MRI volumetric measurements (MRIvol) have been proven reliable in determining mesial temporal atrophy in patients with TLE, We attempted to c orrelate the clinical features with different patterns of hippocampal forma tion (HF) and amygdala (AM) atrophy in patients with TLE without foreign ti ssue lesion. Method's: We studied 65 patients with refractory TLE. They were divided int o five groups according to MRIvol results: pure AM atrophy (n = 11, 10 unil ateral and one bilateral), unilateral HF atrophy in = 16), bilateral HF atr ophy (n = 12, unilateral AM+HF atrophy (n = 13), and patients with normal v olumes of AM and HF (n = 13). MRIvol of AM and HF were performed by using a protocol previously described by Watson et al. (Neurology 1992;42:1743-50) . Results: Patients with AM atrophy had later onset of seizures compared with those with unilateral HF atrophy (p < 0.01). History of febrile convulsion s (p < 0.0001) and frequent secondarily generalized tonic-clonic seizures ( GTCSs) were more often found in patients with HF atrophy compared with thos e with pure AM atrophy and those with normal volumes (p = 0.04). Prolonged postictal confusion was more often found with AM atrophy (p = 0.05). Memory impairment was more severe in patients with HF atrophy than in those with AM atrophy only or in those with normal volumes (p = 0.03). There were no s ignificant differences among the five groups in the following parameters: a ge, duration of epilepsy, seizure frequency, and presence and type of aura. Conclusions: Prolonged postictal confusion appeared to be related to AM atr ophy, in keeping with previous clinical observations. These patients also h ad a lower incidence of early febrile convulsions, older age at epilepsy on set, lower frequency of secondary GTCS, and lesser memory dysfunction compa red with patients with hippocampal atrophy.