Age-Specific Cutoff Scores on a T1-Weighted Axial Medial Temporal-Lobe Atrophy Visual Rating Scale in Alzheimer's Disease Using Clinical Research Center for Dementia of South Korea Data

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.

Clinical outcomes after medial temporal lobe epilepsy surgery: Anterior temporal lobectomy versus selective amygdalohippocampectomy / 中南大学学报(医学版)

Objective:To compare the anterior temporal lobectomy (ATL) with transsylvian selective amygdalohippocampectomy (SeAH) in 72 patients with medial temporal lobe epilepsy (MTLE) regarding the seizure control and neuropsychological outcomes.Methods:Clinical data and follow-up data were collected and retrospectively analyzed.SeAH and ATL were used in 39 and 33 patients,respectively.All eligible patients were followed up at least one year.Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale-Revised were used to test the patients' neuropsychology before and after the surgery for one year.Results:Fifty-nine patients (81.9％) achieved satisfactory seizure control (62.5％ Engel Class Ⅰ and 19.4％ Class Ⅱ).ATL obtained 84.8％ satisfactory seizure control (28 patients),and the success rate was 79.5％ (31 patients) for SeAH.There was no significant difference in seizure control between SeAH and ATL (P=0.760).The postoperative verbal IQ of SeAH group increased significantly in both side surgery (P＜0.05),while the increase was not significant in the group of ATL of both side surgery (P＞0.05).Regarding left-side surgery,postoperative verbal memory and total memory were increased significantly in the group of SeAH (P＜0.05),while the increases were not significant in the group ofATL (P＞0.05).In the right-side surgery,postoperative verbal memory and total memory were increased significantly in the two surgery strategy groups (P＜0.05),while no significant increases were seen in non-verbal memory of the two surgery strategy groups (P＞0.05).Conclusion:Microsurgery for the treatment of refractory MTLE is successful and safe,and should be encouraged.The seizure outcome is not different between ATL and SeAH,while regarding as verbal IQ and verbal memory outcomes,SeAH may be superior to ATL in dominant hemisphere surgery.

Hippocampal Atrophy and Psychotic Symptoms in Patients with Alzheimer's Disease / 신경정신의학

OBJECTIVES: This study examined the difference in the volume or thickness of the medial temporal lobe between Alzheimer's disease patients with psychosis (AD+P) and those without psychosis (AD−P). METHODS: Overall, 31 AD+P patients and 29 AD−P patients were included from the Memory impairment clinics of Pusan National University Hospital in Korea. AD+P was diagnosed according to Jeste and Finkel's proposed diagnostic criteria for psychosis of Alzheimer's disease. AD−P included AD patients with no psychotic symptoms during a 5-year follow-up period. Medial temporal volume or thickness was measured by 3-tesla MRI and freesufer analysis. Analysis of variance was used to examine the difference in the volume or thickness of medial temporal lobe between AP+P and AD−P after controlling for age, gender, education years, Clinical Dementia Rating scale-Sum of Box, and total intracranial volume. RESULTS: The hippocampal volume in AD+P was smaller than that in AD−P. CONCLUSION: These findings suggest that AD+P is associated with a reduced hippocampal volume.

IL-1βstimulated neuron activation via PI3K/Akt/mTOR pathway / 中国病理生理杂志

[ ABSTRACT] AIM:To study the effect of interleukin-1β( IL-1β) on neuron activation during the process of me-dial temporal lobe epilepsy ( MTLE ) .METHODS: IL-1β, rapamycin [ an inhibitor of mammalian target of rapamycin (mTOR)]and lentiviral transfection to knockdown PI3K-p85 were used to pre-treat the neurons.The protein levels of PI3K-p85, p-Akt, p-p70S6K and MAP2 were detected and the relationship among the tested cytokines was analyzed.The neuron endocytosis was observed in each group.RESULTS:IL-1βincreased the protein levels of PI3K-p85, p-Akt and p-p70S6K, up-regulated the expression of PI3K-p85 binding with IL-1RI in the neurons, and increased the neuron endocyto-sis compared with control group (P<0.05) .These processes were inhibited by rapamycin and silence of PI3K-p85 (P<0.05).Inhibition of the PI3K-p85 binding to IL-1RI decreased the protein levels of p-Akt, p-p70S6K and MAP2 which were increased by IL-1βstimulation (P<0.05).CONCLUSION: IL-1βactivates PI3K-p85 by binding with IL-1RI to promote the activation and proliferation of neuron synapses via PI3K/Akt/mTOR signaling pathway, which might be one of the mechanisms in MTLE chronic progress.

The imageology study of patients with the hippocampal sclerosis-associated medial temporal lobe epilep-sy / 中国神经精神疾病杂志

Objective To explore the incidence and imageological features of patients with the hippocampal sclerosis-associated medial temporal lobe epilepsy. Methods Seventy-eight patients with the medial temporal lobe epi?lepsy were recruited from our hospital during February 2012 to December 2013. Magnetic resonance imaging (MRI) and resonance spectroscopy (MRS) analysis were conducted in patients with with the hippocampal sclerosis-associated medial temporal lobe epilepsy, patients with epilepsy without the medial temporal lobe diseases and healthy controls. Results The incidence of hippocampal sclerosis was 58.97%among patients with medial temporal lobe epilepsy which were significantly higher compared with either healthy control group or patients with epilepsy without the medial tempo?ral lobe diseases. The average hippocampal volume of the medial temporal lobe epilepsy group(2305.68±814.61 mm3、2456.71±743. 60 mm3)was significantly smaller compared with either healthy controls or patients with epilepsy without the medial temporal lobe diseases. MRI revealed increased T2WI signal and hippocampal atrophy in 74.55%of patients with hippocampal sclerosis-associated medial temporal lobe epilepsy. Sclerosis was detected on the left side (52.17%) and bilateral hippocampus (19.57%). MRS showed that NAA/(Cr ± Cho) significantly reduced (0.58± 0.19) in the hip?pocampal sclerosis. Conclusions Hippocampal sclerosis may be the main imaging features of the medial temporal lobe epilepsy which are characterized by the hippocampal atrophy and high T2WI signal.

Bilateral stereotactic radiofrequency amygdalohippocampectomy for the treatment of bilateral medial temporal lobe epilepsy / 实用医学杂志

Objective To retrospectively analyze the effect and safety of bilateral stereotactic radiofrequency amygdalohippocampectomy (SAHE) for treatment of bilateral medial temporal lobe epilepsy (BMTLE). Methods Twelve BMTLE patients were treated with bilateral SAHE under limited coagulations. Clinical parameters were evaluated with the programs of Engel′s classification, Liverpool Seizure Severity Scale (LSSS) 2.0, Wechsler Adult Intelligence Scale-Revised (WAIS-R) and Wechsler Memory Scale-Revised (WMS-R), respectively. Results Five patients (42%) were assessed as EngelⅠwith 12 ~ 62-month follow-up. Seizure severity scores were declined sharply compared with the baseline of the patients with out seizure free. Function of memory and intelligence was transiently declined without statistical significance immediately after operation (P >0.05), but was significantly increasedat 6 months after operation (P < 0.05). Conclusion Bilateral SAHE could terminate seizures or reduce seizure severity in patients with BMTLE. Under the circumstance of limited coagulations, neuropsychological function was improved along with seizure control.

Correlación entre la memoria subjetiva y objetiva episódica en pacientescon epilepsia del lóbulo temporal medial intratable / Correlation between subjective memory and episodic objective memory in patients with intractable medial temporal lobe epilepsy

Introducción. En la literatura científica revisada prevalece una discordancia en las investigaciones sobre la relación entre la memoria subjetiva y objetiva en pacientes con Epilepsia del Lóbulo Temporal medial intratable (ELTmi). Objetivo. Identificar la existencia o no de relación entre la memoria subjetiva y objetiva episódica en pacientes con ELTmi. Metodología. Se estudiaron 32 pacientes, con edades entre 15 y 60 años, empleándose el método clínico. Se aplicó una entrevista semiestructurada, el Cuestionario de Eficiencia de Memoria; el Test de aprendizaje verbal-auditivo de Rey y el Test de reproducción y copia de la figura compleja de Rey-Osterreith. Se realizó el procesamiento de los datos obtenidos. Resultados. Los pacientes reportaron quejas sobre su memoria. La modalidad viso-perceptual se mostró preservada, no así en la verbal-auditiva. No existieron diferencias en función de la lateralización de la zona de inicio ictal para ambas modalidades. Se evidenció una correlación negativa entre la memoria subjetiva y la estabilidad de la huella (modalidad verbal-auditiva). Los pacientes con lateralización izquierda mostraron correlación positiva entre la memoria subjetiva y el recuerdo demorado (modalidad viso-perceptual). Conclusiones. Los pacientes mostraron afectación de la memoria subjetiva, independientemente de la lateralización. También revelaron un perfil heterogéneo en la memoria objetiva episódica; así como la existencia de relación entre la memoria subjetiva y la objetiva episódica en la estabilidad de la huella (modalidad verbal-auditiva) y el recuerdo demorado (modalidad viso-perceptual) solo en los pacientes con lateralización izquierda.

Introduction. In the scientific literature there is not agreement about the existence of relationship between subjective memory and the episodic objective memory in untreatable medial temporal lobe epileptic patients (UMTLE). Objective. To identify the presence of relationship between subjective memory and the episodic objective memory in UMTLE patients. Methods. We studied 32 patients, aged 15-60; all of them were interviewed using a semiestructured interview model and a Questionnaire of Memory Efficiency; the Rey´s Auditory Verbal Learning Test and the Reproduction and copy of complex figure Rey-Osterreith. Test data were analyzed. Results. Patients complained about their memory, viso-perceptual modality was preserved but verbal-auditive modality did not. We didnot find any differences related to the lateralization of the ictal zone for both modalities. There was a negative correlation between the subjective memory and the verbal-auditive modality. Patients with left side lateralization showed a positive correlation between the subjective memory and the delayed viso-perceptual memory type. Conclusions. Patients had abnormalities in the subjective memory unrelated to the lateralization. They also had an heterogeneous profile in the episodic memory and the existence of relationship between subjective memory and the episodic objective memory (verbal-auditive), and a delayed visoperceptual memory type only in patients with left lateralization.

Predictive Factors for Decline in Activities of Daily Living in Alzheimer's Disease Dementia with More than 2 Follow-up

BACKGROUND: Impairment in activities of daily living (ADL) is a major problem in Alzheimer's disease (AD), and is related to increased caregiver burden.The present study evaluated whether there are any components of initial dementia evaluation that could predict ADL decline in years follow-up. METHODS: The 32 subjects underwent more than two consecutive neuropsychological evaluation and maintained anti-dementia medication from the Ewha Dementia Cohort. The first clinical, neuropsychological test results, medial temporal atrophy rating and white matter ratings were correlated with the final ADL scores. The subjects were further divided into ADL-preserved and declined groups for the comparison depending on final ADL scores. RESULTS: The annual decline of the Korean Mini-mental status examination (K-MMSE) score was 1.5+/-1.2 and of the Seoul-instrumental ADL score was 6.1+/-4.6. The Factors correlated with the ADL at baseline were the clinical dementia rating, K-MMSE, memory function score and the total neuropsychological test score, left medial temporal lobe atrophy rating, and the neuropsychiatric total score. Only the neuropsychological component including total test, frontal and visuospatial function scores were statistically different between the two groups in the baseline evaluation. CONCLUSIONS: The result of our preliminary study emphasize the other study results that the initial cognitive and dementia status are the strong predictive factors not only for the initial ADL dysfunction but also for the ADL decline in years followed-up dementia cohort.

Alice in Wonderland Syndrome in a Case with Infarct in the Right Medial Temporal Lobe

We describe a patient who suffered an infarct of the right medial temporal lobe, and developed visual illusions for body images, referred to as Alice in wonderland syndrome (AIWS). Although, these phenomena are usually seen in settings of migraine with aura or epilepsy, an association with strokes has not previously been described. The occurrence of AIWS in our patient, following an infarct of the right medial temporal lobe, provides support for this symptom having a biological and anatomical substrate.

Encoding and Retrieval of Words and Scenes Assessed by Functional MRI in Normal Right-Handed Volunteers / 대한간질학회지

PURPOSE: To find the activation patterns of frontal and medial temporal lobe during memory tasks (encoding and retrieval) with novel stimuli (words, scenes) in normal right-handed volunteers. Another aim is to examine which memory paradigms and processes are effective to activate medial temporal lobe. METHODS: We included 10 right-handed normal volunteers. Stimuli consisted of encoding and retrieval of novel word (15 items)/novel scenes (15 items). During scanning, each stimulus was presented for 2000 ms. Imaging was performed on 1.5 GE scanner. Group analysis was performed in volunteers with SPM 2 (uncorrected p10). RESULTS: Scenes encoding and retrieval activated both medial temporal lobes, more on the right side. Word encoding activated predominantly dominant frontal lobe, but failed to activate the medial temporal lobes. The word stimuli activated more the frontal lobe than the picture stimuli. Retrieval process activated more the medial temporal lobe than encoding process. CONCLUSION: Our results showed that the scenes encoding/retrieval and word retrieval are useful to activate the medial temporal lobe and word encoding is useful for activating dominant frontal lobe. Further studies will be necessary in patient groups with unilateral temporal lobe lesion to document the usefulness of this study.

Voxel-based Morphometry (VBM) Based Assessment of Gray Matter Loss in Medial Temporal Lobe Epilepsy: Comparison with FDG PET / 대한핵의학회잡지

PURPOSE: The aims of this study were to find brain regions in which gray matter volume was reduced and to show the capability of voxel-based morphometry (VBM) analysis for lateralizing epileptogenic zones in medial temporal lobe epilepsy (mTLE). The findings were compared with fluorodeoxyglucose positron emission tomography (FDG PET). MATERIALS AND METHODS: MR T1-weighted images of 12 left mTLE and 11 right mTLE patients were compared with those of 37 normal controls. Images were transformed to standard MNI space and averaged in order to create study-specific brain template. Each image was normalized to this local template and brain tissues were segmented. Modulation VBM analysis was performed in order to observe gray matter volume change. Gray matter was smoothed with a Gaussian kernel. After these preprocessing, statistical analysis was performed using statistical parametric mapping software (SPM99). FDG PET images were compared with those of 22 normal controls using SPM. RESULTS: Gray matter volume was significantly reduced in the left amygdala and hippocampus in left mTLE. In addition, volume of cerebellum, anterior cingulate, and fusiform gyrus in both sides and left insula was reduced. In right mTLE, volume was reduced significantly in right hippocampus. In contrast, FDG uptake was decreased in broad areas of left or right temporal lobes in left TLE and right TLE, respectively. CONCLUSIONS: Gray matter loss was found in the ipsilateral hippocampus by modulation VBM analysis in medial temporal lobe epilepsy. This VBM analysis might be useful in lateralizing the epileptogenic zones in medial temporal lobe epilepsy, while SPM analysis of FDG PET disclosed hypometabolic epileptogenic zones.

Limited Predictive Ability of Hippocampal Single Voxel MR Spectroscopy in Surgically Proven Epilepsy

OBJECTIVE: The authors evaluate the predictability of single voxel proton magnetic resonance spectroscopy(MRS) for hippocampal abnormalities in medial temporal lobe epilepsy(MTLE), lateral temporal lobe epilepsy(latTLE) and extratemporal lobe epilepsy(extraTLE). METHODS: Twenty healthy volunteers and 42 patients with MTLE, 17 with latTLE and 23 with extraTLE, were examined preoperatively with MRS. The NAA/(Cho+Cr) ratios were calculated from the MRS peaks obtained bilaterally from both hippocampi. RESULTS: The mean NAA/(Cr+Cho) ratios showed a stepwise increase from the ipsilateral hippocampus in the MTLE group to the normal control group. In the 42 MTLE patients, the mean NAA/(Cho+Cr) ratio value for the ipsilateral hippocampus was 0.39. This was 17.3% lower than the 0.489 measured for the contralateral hippocampus (p=0.005). This was also significantly lower when compared with the hippocampi of latTLE and extraTLE patients ipsilateral to the epileptogenic zone and also with the normal control group (p< 0.05). The mean ratio value of the contralateral hippocampi was also significantly lower when compared with the normal control group (p=0.000). The mean ratio value measured on postoperative MRS showed little metabolic recovery in the MTLE (from 0.455 to 0.481, p=0.48) compared to the latTLE (from 0.438 to 0.52, p=0.09). CONCLUSION: The MRS might be inconclusive in determining whether the non-epileptogenic hippocampus is affected by epileptiform discharge propagation from the epileptogenic hippocampus or from the remote epileptogenic zone other than the hippocampus. Therefore, physicians should be cautious when determining whether the contralateral hippocampus in MTLE or both hippocampi in neocortical epilepsy is abnormal and whether they should be resected together with the epileptogenic zone.

Brain Mapping of Episodic Memory in Patients with Medial Temporal Lobe Epilepsy Using Activation Positron Emission Tomography

BACKGROUND: We aimed to study the regional cerebral PET activation patterns during memory tests in medial temporal lobe epilepsy (mTLE) patients and to see whether the activation study could lateralize memory dominance. METHODS: Participants included 6 right mTLE patients, 6 left mTLE patients, and 6 controls. Language was dominant in the left hemisphere in all the participants. PETs were performed while presenting a set of 30 line drawings of com-mon objects with 4 second intervals between each drawing. After 30 minutes, PETs were repeated while presenting a set of drawings with half of the obejcts changed. RESULTS: During the encoding, activated areas were dispersed in mTLE in the superior frontal gyrus, the primary sensory cortex, the premotor area, the supramarginal and angular gyri ipsilaterally or contralaterally, in addition to the inferior and middle frontal gyri activated in the controls. During the retrieval, activated areas were localized in the bilateral inferior frontal gyri and the right medial temporal area in the controls, but also in the premotor area, the primary sensory cortex, and the angular gyrus in mTLE. In the encoding and also in the retrieval, the activated fields of the prefrontal areas contralateral to the epileptogenic zone became wider compared to the controls and those ipsilateral to the epileptogenic zone became smaller. CONCLUSIONS: Cortical areas involved in the encoding and retrieval of the episodic memory are dispersed and contralaterally lateralized to the epileptogenic zone. Lateralization is most prominent in the prefrontal areas.

Effect of Material-specificity on the Wada Memory Test in Medial Temporal Lobe Epilepsy with Hippocampal Sclerosis

BACKGROUNDS: The Wada test is a useful method in predicting the laterality of a epileptogenic zone. However, past research reveals that material specificity has an influence on the lateralization We examined the material-specificity of memory and its change in epileptic patients to discover reasonable items on the Wada test for the proper lateralization of the epileptogenic zone. METHODS: We analyzed 45 patients with video-EEG-confirmed medial temporal lobe epilepsy (mTLE) and definite hippocampal atrophy by an MRI. Eight items were presented during the Wada test including 3 common objects, 1 geometric object, 1 color, 1 word, 1 phrase, and 1 math expression. We checked recognition memo-ry after recovery of hemiparesis and normalization of EEG. RESULTS: For the right mTLE group, recognition memory following a right hemisphere injection was significantly better than a left hemisphere injection for all categories. For the left mTLE group, a significant difference of scores was found for the left versus right hemisphere injection for common objects. When injected to the left hemisphere, all the items helped lateralization, but when injected to the right hemisphere, a phrase did not help with lateralization. CONCLUSIONS: Items with strong unilateral encodings do not help lateralizing the epileptogenic zone.

Role of medial temporal lobe structure in generating P_(300)——a preliminary study of ERPs in a patient following left temporal lobectomy / 临床神经病学杂志

Objective To explore the role of medial temporal lobe (MTL) structure in generating P 300.Methods Event-related potentials (ERPs) were performed in the patient following left lateral anterior temporal lobectomy and 17 health subjects. Two models of vision and auditus were involved in the study.Results The latency, amplitude and sideway distribution of auditory and visual P 300 were in the normal range gained from the healthy controls.Conclusion MTL structure may be not important in generating scalp P 300.

A Surgical Approach in Arteriovenous Malformation of the Medical Temporal Lobe

Arteriovenous malformation(AVM) of the medial temporal lobe would be interesting to neurosurgeons enough to draw their attentions because it's obscure location, making resection more difficult than the usual AVM and high possibility of operative morbidity caused by intraventricular hermorrhage and/or injury of the adjacent structures such as optic tract, brain stem and basal ganglia. A patient who underwent successful excision of AVM of this region is presented. It has ben confirmed that a transcortical surgical approach through the inferior portion of the temporal lobe could minimize retraction of the brain to avoid operative morbidity and manage a main feeding artery without difficulty.