Mesial temporal lobe epilepsy with amygdalar hamartoma-like lesion: Is it a distinct syndrome?

• Published in: Epilepsy research 2023-05, Vol.192, p.107140-107140, Article 107140
• Main Authors: Okayama, Kiminobu, Usui, Naotaka, Matsudaira, Takashi, Kondo, Akihiko, Araki, Yasukiyo, Kawaguchi, Norihiko, Matsuda, Kazumi, Tottori, Takayasu, Terada, Kiyohito, Matsumoto, Riki, Takahashi, Yukitoshi
• Format: Article
• Language: English
• Subjects: Adult; Amygdala; EEG; Electroencephalography; Epilepsy - pathology; Epilepsy, Temporal Lobe - diagnostic imaging; Epilepsy, Temporal Lobe - pathology; Epilepsy, Temporal Lobe - surgery; Female; Hamartoma; Hippocampus - pathology; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychology; Retrospective Studies; Sclerosis - pathology; Seizures - diagnostic imaging; Seizures - pathology; Seizures - surgery; Semiology; Surgery; Syndrome; Young Adult
• ISSN: 0920-1211; 1872-6844
• DOI: 10.1016/j.eplepsyres.2023.107140

We examined the clinical, semiological, scalp electroencephalographic (EEG), and neuropsychological features of patients with amygdalar hamartoma-like lesion (AHL) without hippocampal sclerosis (HS). This retrospective study included 9 patients with mesial temporal lobe epilepsy (MTLE) who had an amygdalar lesion on preoperative MRI; underwent mesial temporal resection; were diagnosed with amygdalar hamartoma-like lesion (AHL) without hippocampal sclerosis (HS); were followed up for at least 2 years after surgery; and had a favourable postoperative seizure outcome (Engel Class I). There were 5 women and 4 men, and age at surgery ranged from 19 to 54 (mean, 36.6) years. Clinical characteristics, auras, video-recorded seizure semiology, interictal and ictal EEG, and preoperative neuropsychological data were reviewed. Twenty patients with MTLE with HS who had favourable postoperative seizure outcomes (Engel Class I) were selected as controls. Age at seizure onset was significantly higher in patients with AHL without HS than in those with HS. Fear was more frequently seen in patients with AHL (44 %) than in those with HS (5 %) (P = 0.022). There were no significant differences in interictal epileptiform discharges or ictal EEG pattern. Preoperative full-scale IQ score was significantly higher in the AHL group than in the HS group (mean, 92.9 v. 74.8, P = 0.004), as was preoperative memory quotient score (mean 100.7 v. 85.1, P = 0.028). We clarified the clinical, semiological, and neuropsychological features of patients with MTLE-AHL. These findings may be useful for preoperative evaluation, especially of patients with suspected MTLE but without apparent HS on preoperative MRI. •Amygdalar hamartoma (AH) without hippocampal sclerosis (HS) was examined.•All the patients underwent epilepsy surgery with favourable seizure outcome.•Age at seizure onset was higher in AHL group than in HS group.•Fear was more frequently seen in AHL group than in HS group.•Preoperative IQ and memory scores were higher in AHL group than in HS group.