Spatial patterns of gray and white matter compromise relate to age of seizure onset in temporal lobe epilepsy

•We explored the spatial patterns of cortico-subcortical gray and white matter injury in a population of temporal lobe epilepsy (TLE) patients.•Our results supported unique spatial patterns of cortical atrophy and superficial white matter (SWM) microstructural damage in TLE.•Those features seemed to...

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Published inNeuroImage clinical Vol. 39; p. 103473
Main Authors Ballerini, Alice, Arienzo, Donatello, Stasenko, Alena, Schadler, Adam, Vaudano, Anna Elisabetta, Meletti, Stefano, Kaestner, Erik, McDonald, Carrie R.
Format Journal Article
LanguageEnglish
Published Netherlands Elsevier Inc 01.01.2023
Elsevier
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Summary:•We explored the spatial patterns of cortico-subcortical gray and white matter injury in a population of temporal lobe epilepsy (TLE) patients.•Our results supported unique spatial patterns of cortical atrophy and superficial white matter (SWM) microstructural damage in TLE.•Those features seemed to be related to each other based on when the seizures began.•Developing TLE during childhood lead to a relationship between hippocampal damage and SWM injury of the majority of the hemisphere ipsilateral to the seizure focus.•Developing TLE during adulthood causes co-occurring cortical thickness and SWM injury in the medial temporal lobe ipsilateral to the epileptogenic focus. Temporal Lobe Epilepsy (TLE) is frequently a neurodevelopmental disorder, involving subcortical volume loss, cortical atrophy, and white matter (WM) disruption. However, few studies have addressed how these pathological changes in TLE relate to one another. In this study, we investigate spatial patterns of gray and white matter degeneration in TLE and evaluate the hypothesis that the relationship among these patterns varies as a function of the age at which seizures begin. Eighty-two patients with TLE and 59 healthy controls were enrolled. T1-weighted images were used to obtain hippocampal volumes and cortical thickness estimates. Diffusion-weighted imaging was used to obtain fractional anisotropy (FA) and mean diffusivity (MD) of the superficial WM (SWM) and deep WM tracts. Analysis of covariance was used to examine patterns of WM and gray matter alterations in TLE relative to controls, controlling for age and sex. Sliding window correlations were then performed to examine the relationships between SWM degeneration, cortical thinning, and hippocampal atrophy across ages of seizure onset. Cortical thinning in TLE followed a widespread, bilateral pattern that was pronounced in posterior centroparietal regions, whereas SWM and deep WM loss occurred mostly in ipsilateral, temporolimbic regions compared to controls. Window correlations revealed a relationship between hippocampal volume loss and whole brain SWM disruption in patients who developed epilepsy during childhood. On the other hand, in patients with adult-onset TLE, co-occurring cortical and SWM alterations were observed in the medial temporal lobe ipsilateral to the seizure focus. Our results suggest that although cortical, hippocampal and WM alterations appear spatially discordant at the group level, the relationship among these features depends on the age at which seizures begin. Whereas neurodevelopmental aspects of TLE may result in co-occurring WM and hippocampal degeneration near the epileptogenic zone, the onset of seizures in adulthood may set off a cascade of SWM microstructural loss and cortical atrophy of a neurodegenerative nature.
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Both authors contributed equally as senior authors.
ISSN:2213-1582
2213-1582
DOI:10.1016/j.nicl.2023.103473