The amygdala and temporal lobe simple partial seizures: A prospective and quantitative MRI study

Purpose: To determine whether specific temporal lobe simple partial seizure s (SPSs) are associated with an abnormal amygdala T-2 (AT(2)) ipsilateral t o the seizure focus in patients with intractable unilateral temporal lobe e pilepsy (TLE). AT(2) relaxation time mapping is a sensitive method for the detection of abnormal tissue in the amygdala in patients with refractory TL E. The relation between an abnormal AT(2) in the epileptic temporal lobe an d amygdala seizure onset has not been established. Methods: Fifty patients with intractable unilateral TLE and concordant data during presurgical evaluation were included. Patients with a foreign-tissu e lesion on standard magnetic resonance imaging (MRI) were excluded. All ha d AT(2) mapping. Fifteen types of SPSs were ascertained prospectively, syst ematically, and blinded to the results of AT(2) mapping. The SPSs of patien ts with a normal AT(2) (n = 25) were compared with those of patients with a n abnormal AT(2) ipsilateral to the seizure focus (n = 25). Results: The group of patients with an abnormal AT(2) reported a median of six types of SPSs (range 1-11), in comparison with a median of three types of SPSs (range, 0-7) for the group with a normal AT(2) (p <0.01). Deja vu, a warm sensation, an indescribable strange sensation, a cephalic sensation, and fear were associated with an abnormal AT(2). The combination of deja v u, a cephalic sensation, a warm sensation, a gustatory hallucination, and a n indescribable strange sensation discriminated best, between the 25 patien ts with a normal and the 25 patients with an abnormal AT(2.) Conclusions: A high number and the types of different SPSs provide clinical evidence for early involvement of the amygdala during seizures in patients with refractory unilateral TLE and an abnormal AT(2) in the epileptic temp oral lobe.