Abstracts

To evaluate the relationship between hippocampal volume loss, depression, and epilepsy.
There is a significantly increased incidence of depression and suicide in patients with epilepsy. Both epilepsy and depression are associated with reduced hippocampal volumes, but it is uncertain whether patients with both conditions have greater atrophy than those with epilepsy alone. Previous studies used depression measures strongly weighted to current state, and did not necessarily assess the influence of chronic major depressive disorder ([ldquo]trait[rdquo]), which could have a greater impact on hippocampal volume., Sixty-one epilepsy patients with complex partial seizures (CPS) confirmed by ictal video-EEG had 3D spoiled gradient recalled acquisition (spgr) with 1.5 mm slice MRI Scans. These were loaded into a linux based system, hippocampi were manually traced on each slice, and then assembled into 3 dimensional volumes. The anterior head of the hippocampus was separated from the amygdala by the appearance of the inferior limb of the lateral ventricle. The hippocampus was traced superiorly around the choroidal fissure, curving laterally along the medial border of the temporal horn, and medially along the gray matter of the hippocampus up to its junction with the parahippocampal gyrus. Depression screening was performed with Beck Depression Inventory (BDI, 56 patients) and with the structured clinical inventory for DSM-IV (SCID, 36 patients). For the BDI, a score above 10 was considered mild to moderate, above 20 moderate to severe, and above 30 severe depression. MRI and clinical analysis were performed blinded to other data. Statistical analysis was performed with Systat (Point Richmond CA) using Student[apos]s T-test and analysis of variance., SCID evaluation revealed 20 patients with and 16 without depression. BDI revealed 24 and 32, respectively. There was no relationship between the right or left hippocampal volumes and depression for either measure. There was a clear and expected relationship between hippocampal volume and the side of the seizure focus (p=0.001). However, this was not affected by the presence of depression based on SCID or BDI., We found no significant effect of depression, using measures of train as well as state, on hippocampal volume in patients with CPS. The high rate of comorbidity may be better evaluated with measures of cellular function rather than by anatomic imaging of the hippocampus., (Supported by National Institutes of Health.)