Hippocampal alterations in children with temporal lobe epilepsy with or without a history of febrile convulsions: Evaluations with MR volumetry and proton MR spectroscopy

Wen Chau Wu, Chao Ching Huang, Hsiao Wen Chung, Michelle Liou, Chun Jen Hsueh, Chang Shin Lee, Ming Long Wu, Cheng Yu Chen

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Abstract

BACKGROUND AND PURPOSE: The causal effect of early febrile convulsions (FC) on later-onset temporal lobe epilepsy (TLE) remains unclear. In this study, we sought to examine the hippocampal alterations in epileptic children with or without FC history by using MR spectroscopy and volumetry. METHODS: Fifty-five children ranging in age from 18 months to 15 years were enrolled in this study. Subjects were divided into three groups: the control group without either TLE or history of FC (n = 16), the TLE group with early history of FC (TLE + FC; n = 22), and the TLE group without FC history (n = 17). Measurement of hippocampal volume (HV) was performed on thin section T1-weighted images acquired with a 3D gradient echo MR image and normalized by the intracranial volume. Each individual subject had two measures of lateralization; one gives the smaller side of HV and the other the contralateral larger side of HV, assuming that the side with smaller HV is the possible primary site of seizure focus and the contralateral larger HV the secondary or normal site. Single-voxel proton MR spectroscopy of the hippocampi was performed, with metabolic ratio N-acetylaspartate (NAA)/choline (Cho) + creatine plus phosphocreatine (Cr) calculated and grouped separately as were with volumetry. RESULTS: The overall mean HV for the control group was 2.61 ± 0.21 cm3 at an average intracranial volume of 965 ± 241 cm3, and the asymmetry index for hippocampal volume was (2.32 ± 1.58)%. The overall mean HV was 2.30 ± 0.33 cm3 for TLE + FC group and 2.34 ± 0.33 cm3 for TLE group. Mean HV differed significantly for the three groups (P < .01). When the small and large sides were analyzed separately, significant differences were found between control and TLE as well as between control and TLE + FC for the smaller side (P < .05), whereas for the larger side significant differences were found only between control and TLE + FC. In MR spectroscopic measurements, the mean NAA/(Cr + Cho) of bilateral hippocampi was 0.77 ± 0.06 for control group, 0.62 ± 0.12 for TLE + FC group, and 0.66 ± 0.11 for TLE group. In terms of statistically significant difference between groups, spectroscopic results were similar to volumetric measurements, except that there was no significant interaction effect between groups and measures of asymmetrical indices (P = .272). CONCLUSION: Children with TLE and early history of FC tend to have lower hippocampal volumes and NAA/(Cr + Cho) ratios than do TLE children without FC history. The TLE + FC group seems to have increased vulnerability of the contralateral hippocampus as compared with TLE group. MR volumetry and spectroscopy are equally capable of showing the trends of hippocampal alternations in children with TLE with or without FC history.

Original languageEnglish
Pages (from-to)1270-1275
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume26
Issue number5
Publication statusPublished - 2005 Dec 1

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Febrile Seizures
Temporal Lobe Epilepsy
Protons
Magnetic Resonance Spectroscopy
Choline
Hippocampus
Control Groups
Phosphocreatine
Creatine

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

@article{18aeb13a125940c8baad721b79b0fa1e,
title = "Hippocampal alterations in children with temporal lobe epilepsy with or without a history of febrile convulsions: Evaluations with MR volumetry and proton MR spectroscopy",
abstract = "BACKGROUND AND PURPOSE: The causal effect of early febrile convulsions (FC) on later-onset temporal lobe epilepsy (TLE) remains unclear. In this study, we sought to examine the hippocampal alterations in epileptic children with or without FC history by using MR spectroscopy and volumetry. METHODS: Fifty-five children ranging in age from 18 months to 15 years were enrolled in this study. Subjects were divided into three groups: the control group without either TLE or history of FC (n = 16), the TLE group with early history of FC (TLE + FC; n = 22), and the TLE group without FC history (n = 17). Measurement of hippocampal volume (HV) was performed on thin section T1-weighted images acquired with a 3D gradient echo MR image and normalized by the intracranial volume. Each individual subject had two measures of lateralization; one gives the smaller side of HV and the other the contralateral larger side of HV, assuming that the side with smaller HV is the possible primary site of seizure focus and the contralateral larger HV the secondary or normal site. Single-voxel proton MR spectroscopy of the hippocampi was performed, with metabolic ratio N-acetylaspartate (NAA)/choline (Cho) + creatine plus phosphocreatine (Cr) calculated and grouped separately as were with volumetry. RESULTS: The overall mean HV for the control group was 2.61 ± 0.21 cm3 at an average intracranial volume of 965 ± 241 cm3, and the asymmetry index for hippocampal volume was (2.32 ± 1.58){\%}. The overall mean HV was 2.30 ± 0.33 cm3 for TLE + FC group and 2.34 ± 0.33 cm3 for TLE group. Mean HV differed significantly for the three groups (P < .01). When the small and large sides were analyzed separately, significant differences were found between control and TLE as well as between control and TLE + FC for the smaller side (P < .05), whereas for the larger side significant differences were found only between control and TLE + FC. In MR spectroscopic measurements, the mean NAA/(Cr + Cho) of bilateral hippocampi was 0.77 ± 0.06 for control group, 0.62 ± 0.12 for TLE + FC group, and 0.66 ± 0.11 for TLE group. In terms of statistically significant difference between groups, spectroscopic results were similar to volumetric measurements, except that there was no significant interaction effect between groups and measures of asymmetrical indices (P = .272). CONCLUSION: Children with TLE and early history of FC tend to have lower hippocampal volumes and NAA/(Cr + Cho) ratios than do TLE children without FC history. The TLE + FC group seems to have increased vulnerability of the contralateral hippocampus as compared with TLE group. MR volumetry and spectroscopy are equally capable of showing the trends of hippocampal alternations in children with TLE with or without FC history.",
author = "Wu, {Wen Chau} and Huang, {Chao Ching} and Chung, {Hsiao Wen} and Michelle Liou and Hsueh, {Chun Jen} and Lee, {Chang Shin} and Wu, {Ming Long} and Chen, {Cheng Yu}",
year = "2005",
month = "12",
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language = "English",
volume = "26",
pages = "1270--1275",
journal = "American Journal of Neuroradiology",
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Hippocampal alterations in children with temporal lobe epilepsy with or without a history of febrile convulsions : Evaluations with MR volumetry and proton MR spectroscopy. / Wu, Wen Chau; Huang, Chao Ching; Chung, Hsiao Wen; Liou, Michelle; Hsueh, Chun Jen; Lee, Chang Shin; Wu, Ming Long; Chen, Cheng Yu.

In: American Journal of Neuroradiology, Vol. 26, No. 5, 01.12.2005, p. 1270-1275.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Hippocampal alterations in children with temporal lobe epilepsy with or without a history of febrile convulsions

T2 - Evaluations with MR volumetry and proton MR spectroscopy

AU - Wu, Wen Chau

AU - Huang, Chao Ching

AU - Chung, Hsiao Wen

AU - Liou, Michelle

AU - Hsueh, Chun Jen

AU - Lee, Chang Shin

AU - Wu, Ming Long

AU - Chen, Cheng Yu

PY - 2005/12/1

Y1 - 2005/12/1

N2 - BACKGROUND AND PURPOSE: The causal effect of early febrile convulsions (FC) on later-onset temporal lobe epilepsy (TLE) remains unclear. In this study, we sought to examine the hippocampal alterations in epileptic children with or without FC history by using MR spectroscopy and volumetry. METHODS: Fifty-five children ranging in age from 18 months to 15 years were enrolled in this study. Subjects were divided into three groups: the control group without either TLE or history of FC (n = 16), the TLE group with early history of FC (TLE + FC; n = 22), and the TLE group without FC history (n = 17). Measurement of hippocampal volume (HV) was performed on thin section T1-weighted images acquired with a 3D gradient echo MR image and normalized by the intracranial volume. Each individual subject had two measures of lateralization; one gives the smaller side of HV and the other the contralateral larger side of HV, assuming that the side with smaller HV is the possible primary site of seizure focus and the contralateral larger HV the secondary or normal site. Single-voxel proton MR spectroscopy of the hippocampi was performed, with metabolic ratio N-acetylaspartate (NAA)/choline (Cho) + creatine plus phosphocreatine (Cr) calculated and grouped separately as were with volumetry. RESULTS: The overall mean HV for the control group was 2.61 ± 0.21 cm3 at an average intracranial volume of 965 ± 241 cm3, and the asymmetry index for hippocampal volume was (2.32 ± 1.58)%. The overall mean HV was 2.30 ± 0.33 cm3 for TLE + FC group and 2.34 ± 0.33 cm3 for TLE group. Mean HV differed significantly for the three groups (P < .01). When the small and large sides were analyzed separately, significant differences were found between control and TLE as well as between control and TLE + FC for the smaller side (P < .05), whereas for the larger side significant differences were found only between control and TLE + FC. In MR spectroscopic measurements, the mean NAA/(Cr + Cho) of bilateral hippocampi was 0.77 ± 0.06 for control group, 0.62 ± 0.12 for TLE + FC group, and 0.66 ± 0.11 for TLE group. In terms of statistically significant difference between groups, spectroscopic results were similar to volumetric measurements, except that there was no significant interaction effect between groups and measures of asymmetrical indices (P = .272). CONCLUSION: Children with TLE and early history of FC tend to have lower hippocampal volumes and NAA/(Cr + Cho) ratios than do TLE children without FC history. The TLE + FC group seems to have increased vulnerability of the contralateral hippocampus as compared with TLE group. MR volumetry and spectroscopy are equally capable of showing the trends of hippocampal alternations in children with TLE with or without FC history.

AB - BACKGROUND AND PURPOSE: The causal effect of early febrile convulsions (FC) on later-onset temporal lobe epilepsy (TLE) remains unclear. In this study, we sought to examine the hippocampal alterations in epileptic children with or without FC history by using MR spectroscopy and volumetry. METHODS: Fifty-five children ranging in age from 18 months to 15 years were enrolled in this study. Subjects were divided into three groups: the control group without either TLE or history of FC (n = 16), the TLE group with early history of FC (TLE + FC; n = 22), and the TLE group without FC history (n = 17). Measurement of hippocampal volume (HV) was performed on thin section T1-weighted images acquired with a 3D gradient echo MR image and normalized by the intracranial volume. Each individual subject had two measures of lateralization; one gives the smaller side of HV and the other the contralateral larger side of HV, assuming that the side with smaller HV is the possible primary site of seizure focus and the contralateral larger HV the secondary or normal site. Single-voxel proton MR spectroscopy of the hippocampi was performed, with metabolic ratio N-acetylaspartate (NAA)/choline (Cho) + creatine plus phosphocreatine (Cr) calculated and grouped separately as were with volumetry. RESULTS: The overall mean HV for the control group was 2.61 ± 0.21 cm3 at an average intracranial volume of 965 ± 241 cm3, and the asymmetry index for hippocampal volume was (2.32 ± 1.58)%. The overall mean HV was 2.30 ± 0.33 cm3 for TLE + FC group and 2.34 ± 0.33 cm3 for TLE group. Mean HV differed significantly for the three groups (P < .01). When the small and large sides were analyzed separately, significant differences were found between control and TLE as well as between control and TLE + FC for the smaller side (P < .05), whereas for the larger side significant differences were found only between control and TLE + FC. In MR spectroscopic measurements, the mean NAA/(Cr + Cho) of bilateral hippocampi was 0.77 ± 0.06 for control group, 0.62 ± 0.12 for TLE + FC group, and 0.66 ± 0.11 for TLE group. In terms of statistically significant difference between groups, spectroscopic results were similar to volumetric measurements, except that there was no significant interaction effect between groups and measures of asymmetrical indices (P = .272). CONCLUSION: Children with TLE and early history of FC tend to have lower hippocampal volumes and NAA/(Cr + Cho) ratios than do TLE children without FC history. The TLE + FC group seems to have increased vulnerability of the contralateral hippocampus as compared with TLE group. MR volumetry and spectroscopy are equally capable of showing the trends of hippocampal alternations in children with TLE with or without FC history.

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