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Septal Nuclei Enlargement in Temporal Lobe Epilepsy Without Mesial Temporal Sclerosis

Epilepsy News From: Wednesday, March 13, 2013

In the January 28th issue of the journal Neurology, Drs. Butler and colleagues from the Department of Neurology at New York University Medical Center, the Center for Molecular and Behavioral Neurosciences at the State University of New Jersey-Newark and the Multimodal Imaging Laboratory at the University of California, San Diego, present a fascinating study regarding imaging performed in patients with epilepsy. Specifically, the authors set out to measure the volume of a particular area of the brain known as the basal forebrain septal nuclei in patients who have temporal lobe epilepsy and compare this area to those patients with epilepsy that is not located in the temporal lobe. It has been observed that in animal models with temporal lobe epilepsy, septal lesions seem to help promote the process of epilepsy while septal stimulation can be anti-epileptic.

Individuals with epilepsy were recruited from two sites and consisted of patients with drug-resistant epilepsy; 20 with temporal lobe epilepsy and mesial temporal lobe sclerosis; 24 with temporal lobe epilepsy without mesial temporal lobe sclerosis; 23 with extra temporal epilepsy; and 114 controls. Septal volume was measured using high-resolution MRI in association with newly developed probabilistic septal nuclei maps, and the volume was compared between subject groups while controlling for factors that may perhaps confuse the analysis.

The investigators found that patients with temporal lobe epilepsy without mesial temporal sclerosis had significantly larger septal nuclei than patients with extra-temporal epilepsy in controls. This is not true for patients with mesial temporal sclerosis. The results were interpreted with reference to prior studies demonstrating expansion of the septohippocampal cholinergic system in animal models with temporal lobe epilepsy in human temporal lobe epilepsy surgical specimens. The authors went on to conclude that septal nuclei are enlarged in patients with temporal lobe epilepsy without mesial temporal lobe sclerosis. Moreover, more research is needed in septal nuclei and anti-epileptic septohippocampal neurocircuitry that could be relevant to the development of new interventions or treatments that would involve septal stimulation for refractory temporal lobe epilepsy.

This small study is important because it provides the possibility of a new target for treatment of drug-resistant epilepsy, a target that has not previously been used in other therapies. Clearly, more understanding of the role of this portion of the brain needs to be explored, but yet this represents another hopeful sign of another avenue for potential future treatment development.

Authored by

Joseph I. Sirven MD

Reviewed Date

Wednesday, March 19, 2014

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