A study on brain asymmetry in temporal lobe epilepsy

Objective: Temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS) is the most common type of focal epilepsies. Hemispheric asymmetry is a feature of brain organization in both invertebrates and vertebrates and may be the key to some neurodegenerative diseases. In this context, we aimed to investigate the volumetric asymmetry difference in cerebral structures between TLE patients and the healthy control group, based on magnetic resonance imaging (MRI) data that may be used as a new neuroimaging marker for TLE cases. Patients and Methods: In this retrospective study the cranial MRIs of fourteen clinically manifesting, radiologically HS-identified, and diagnosed TLE patients and fourteen healthy individuals from the Radiology Department of Yeditepe University Hospital were evaluated. Volume measurements and asymmetry index (AI) calculations in the total brain, hippocampus, temporal lobe, amygdala, thalamus, nucleus accumbens (NAc), premotor cortex, primary and somatosensory cortices were performed using the medical NeuroQuant® software. A negative AI value represented asymmetry towards the right due to reduced left hemispheric volume; a positive AI value represented asymmetry towards the left due to reduced right hemispheric volume. Subsequently, differences in volume and asymmetric patterns were investigated among TLE subgroups (right and left-sided TLE) and controls. Results: The left-sided TLE patients showed significant bilateral total brain volume reduction compared to the control group. Significant ipsilateral volumetric declines were also detected in the premotor cortex, the temporal lobe, and NAc with remarkable asymmetry to the right side. No significant changes were detected in right-sided TLE patients compared to the other groups. Conclusion: Overall, findings suggest that TLE patients had volumetric alterations with symmetry changes beyond the mesial temporal structures. With further investigations, the asymmetry measures can provide additional knowledge for TLE diagnosis.