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Quantitative magnetic resonance characterization of mesial temporal sclerosis in childhood

From the Neurosciences Unit (Drs. Scott, Cross, and Neville), the Developmental Cognitive Neuroscience Unit (Dr. Wood), and the Radiology and Physics Unit (Drs. Scott, Gadian, and Connelly), Institute of Child Health, University College London; and Great Ormond Street Hospital for Children National Health Service Trust (Drs. Scott, Cross, and Neville), London, UK.

Address correspondence and reprint requests to Dr. Rod C. Scott, The Wolfson Centre, Mecklenburgh Square, London WC1N 2AP; e-mail: rscott{at}ich.ucl.ac.uk

OBJECTIVE: To investigate whether quantitative MR techniques can be used to distinguish between mesial temporal sclerosis in patients with a history of prolonged febrile convulsion and in patients without such a history.

METHODS: Quantitative hippocampal T2 relaxometry, hippocampal volumetry, and single voxel ¹H-MRS data were acquired from 16 children who subsequently underwent temporal lobe resections for intractable temporal lobe epilepsy and histologically were shown to have sclerosis of the horn of Ammon. Eight children had a history of prolonged febrile convulsion in early childhood and eight children had other or no associations.

RESULTS: Patients with a history of prolonged febrile convulsion had smaller hippocampi (p = 0.02) and prolonged T2 relaxation time (p = 0.03) ipsilateral to the seizure focus when compared with patients without such a history. There was also more side-to-side asymmetry of T2 relaxation time (p = 0.004) and hippocampal volume (p = 0.02) in the patients with a history of prolonged febrile convulsion than in those with other or no associations. No differences between the groups were identified using ¹H-MRS.

CONCLUSIONS: These data support the view that there are at least two types of mesial temporal sclerosis. There may be several pathogenetic pathways from initial insult to later mesial temporal sclerosis, and these pathways are, at least in part, dependent on the initial insult.

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				Y.-t. Ng, A. L. McGregor, D. C. Duane, H. K. Jahnke, C. R. Bird, and J. W. Wheless Childhood Mesial Temporal Sclerosis J Child Neurol, June 1, 2006; 21(6): 512 - 517. [Abstract] [PDF]

				R. C. Scott, M. D. King, D. G. Gadian, B. G. R. Neville, and A. Connelly Hippocampal abnormalities after prolonged febrile convulsion: a longitudinal MRI study Brain, November 1, 2003; 126(11): 2551 - 2557. [Abstract] [Full Text] [PDF]

				R. C. Scott, J. H. Cross, D. G. Gadian, G. D. Jackson, B. G. R. Neville, and A. Connelly Abnormalities in hippocampi remote from the seizure focus: a T2 relaxometry study Brain, September 1, 2003; 126(9): 1968 - 1974. [Abstract] [Full Text] [PDF]