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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 824-828. doi: 10.19723/j.issn.1671-167X.2019.05.006

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Clinico-pathological features of temporal lobe epilepsy with enlarged amygdala

Sha ZHU1,Zong-sheng XU1,Qing XIA1,Xiao-jing FANG1,Dan-hua ZHAO1,Xian-zeng LIU1,2,△()   

  1. 1. Department of Neurology, Peking University International Hospital, Beijing 102206, China
    2. Department of Neurology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2018-01-19 Online:2019-10-18 Published:2019-10-23
  • Contact: Xian-zeng LIU E-mail:liuxianzeng2004@sina.com

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Abstract:

Objective: To summarize the clinical, video electroencephalogram (VEEG), radiological and pathological features of 3 patients of temporal lobe epilepsy (TLE) with amygdala enlargement (AE). Methods: Three TLE patients with AE who were hospitalized in Peking University International Hospital were collected. The above features were retrospectively analyzed, and the amygdala volume was measured as well. Results: Of all the 3 patients, 2 were females and 1 male, whose seizure onset ages varied from 21 to 40 years. Two cases presented with secondarily generalized tonic-clonic seizures after falling asleep during the night. One of the 2 cases had complex partial seizures (CPSs) with episodic memory and automatism after one year, and the third one had CPSs with lip smacking and tongue wagging during the night. All the patients suffered from obvious anxious disorder. Unilateral AE by MRI was de-monstrated in the 3 cases, one on the right side, and the other two on the left side. The average amygdala volume of the enlarged side and the other side were (2 123.7±131.8) mm 3 and (1 276.3±156.9) mm 3, respectively. Unilateral interictal epileptic discharges were ipsilateral to the AE in 2 cases, while the other patient showed bilateral interictal epileptic discharges. The ictal VEEG showed that the seizure onset zone was ipsilateral to the AE and was confined to the anterior and middle temporal regions in the 3 patients. The interictal single-photon emission computed tomography (SPECT) was negative in 2 cases. The interictal positron emission tomography (PET) showed hypometabolism in the AE in one case. The histological pathology revealed focal cortical dysplasia in the amygdala and temporal lobe in the 3 cases, and one of the 3 cases was combined with hippocampal sclerosis. All the patients became seizure free after surgery in the half year following-up. VEEG revealed slow wave activity and occasional spike wave in the operated side. Conclusion: AE may be one subtype of TLE. It is necessary to recognize AE in TLE with MRI-negative. For those poorly responsive to antiepileptic drugs, surgical treatment could provide a better solution. Focal cortical dysplasia may be one of the most common pathological features of TLE with AE.

Key words: Amygdala, Temporal lobe epilepsy, Focal cortical dysplasia

CLC Number: 

  • R742.1

Figure 1

Head MRI Flair image A, amygadala enlargement on the right side (white arrow); B, amygadala enlargement on the left side (white arrow)."

Table 1

The amygdala volumes of the 3 patients"

Patient number Contralateral side/mm3 AE side/mm3
1 1 126 1 979
2 1 439 2 237
3 1 264 2 155

Figure 2

Positron emission tomography examination showed hypometabolism in the enlarged amygdala on the left"

Figure 3

Balloon like cells in the amygdala (black arrow, HE ×40)"

Table 2

Clinical data of 3 patients with temporal lobe epilepsy with enlarged mygdale"

Patient Age at
epilepsy
onset/years		 Gender Seizure
type		 Interictal
scalf
VEEG		 Ictal
scalf
VEEG		 Intracranial
deep
electrode
VEEG		 AE
side		 SGTC
time		 CPS
time		 SGTC
frequency		 CPS
frequency		 Neuropa-
thological
findings		 Postoperative
seizure		 Postoperative
VEEG
1 40 Female CPS Both sides Left Left Sleep,
awake		 1/week FCDⅡb 0 Slow wave in
the operation
area, sharp
wave
occasional
2 35 Female SGTCS Left Left Left Sleep Awake 1-10+/
month		 1-2/
day		 FCDⅢa 0 Same as
above
3 21 Male SGTCS,
CPS		 Right Right Right Right Sleep,
awake		 Awake 1-10+/
month		 1/day FCDⅡb 0 Same as
above
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