Abstracts

RATIONALE: Several studies have shown an association between hippocampal atrophy and signal changes with intractable mesial temporal lobe epilepsy (MTLE). Such relationship has been usually established by tertiary centers. Therefore, a bias may play a role in sampling more severe epilepsy cases. In the present study we evaluate, in patients with MTLE, the imaging and clinical variables that may have a relevance on seizure control.
METHODS: MTLE patients from both general and intractable out-patient clinic of the Clinical Hospital of the University of S[atilde]o Paulo School of Medicine [ndash] Ribeir[atilde]o Preto were evaluated with protocols for the temporal lobe. Patients were considered with good seizure control (GC) if they had less than 4 seizures per year independently on the antiepileptic regime. Patients with one or more seizures/month were considered with poor control (PC). Forty-two GC patients and 44 PC were analyzed. Groups were compared for clinical parameters and hippocampal volume and FLAIR signal.
RESULTS: No statistical differences were observed between the GC and PC groups in the following parameters: age of the patient at the time of study, age of the patient at the time of the initial precipitating injury (IPI) or first epileptic seizure, duration of epilepsy and follow-up, and familiar history of epilepsy. The frequency of IPI was higher in the PC (75.0 % versus 54.8 %, P[lt]0.05, Student t test). No differences in hippocampal volumes between GC and PC were found. Nevertheless, we found a significant increase in FLAIR signal in the atrophic hippocampus of PC when compared with GC (ANOVA, P[lt]0.001).
CONCLUSIONS: These findings suggest that hippocampal atrophy probably does not have influence on seizure outcome whereas the higher intensity of FLAIR signal is correlated with clinical intractability.
[Supported by: CNPq, PRONEX and FAPESP (Proc. 99/11729-2, 00/12376-5); Brazil.]