Grey-white matter abnormalities in temporal lobe epilepsy associated with hippocampal sclerosis: Inter-observer analysis, histopathological findings, and correlation with clinical variables
2012
This study was conducted to determine the incidence of
grey-white matter abnormalities (GWMAs) on magnetic resonance
images (MRIs) in patients with hippocampal sclerosis (HS), to
assess the inter-observer reliability of this finding, and to
establish a possible relationship between GWMA and
histopathological findings in the anterior part of the temporal
lobe, as well as its other relation to clinical variables. We
established a group of 55 patients with histologically proven
HS. Three observers independently reviewed the MRIs to assess
whether GWMA was present. Substantial independent
inter-observer agreement was reached for 44 of the 55 patients
(80%) (Fleiss' kappa 0.732; p<0.0001). GWMAs were present in
38% of patients (HS + GWMA). Focal cortical dysplasia (FCD) of
type Illa (ILAE classification) was present in 31% of patients.
FCD type Illa was present in 52.4% with HS + GWMA, and in 17.6%
without GWMA (HS - GWMA) (p=0.007). We did not find any
statistically significant differences in the postoperative
outcomes between HS + GWMA and HS - GWMA. We did not find any
statistically significant differences in the presence or
absence of GWMA and FCD of the temporal pole in relation to the
onset of epilepsy, the duration of epilepsy, or the presence of
potential epileptogenic insults. GWMA in the anterior part of
temporal lobe in patients with HS is a reliable assessment sign
for observers who are experienced in evaluating the MRIs of
epilepsy patients. The presence of GWMA is significantly
associated with the presence of FCD type Illa in these
patients. The presence or absence of GWMA and FCD type Illa
does not influence the postoperative outcome of HS patients.
(C) 2012 Elsevier B.V. All rights reserved.
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