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Introduction: The use of Magnetic Resonance Imaging (MRI) T2 relaxometry and spectroscopy has added new dimensions to the imaging of Temporal Lobe Epilepsy (TLE). Advanced techniques like MRI diffusion and MRI perfusion are new additions to the MRI protocol for epilepsy. Aim: To study the diagnostic value of T2 relaxation time in Electroencephalogram (EEG) confirmed seizure cases. Materials and Methods: A single-centre, cross-sectional study was conducted at Department of Radiodiagnosis, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, from December 2020 to November 2022 at a tertiary care hospital. All patients were subjected to MRI with a special epilepsy protocol and T2 relaxometry. Hippocampal T2 relaxation values for each slice were measured by placing a Region of Interest (ROI) on the representative image obtained from the T2 relaxometry sequence, focusing on the hippocampus in both the control and study groups. The control group (n=30) consisted of healthy volunteers, whereas the case group (n=36) comprised patients presenting with a history of seizures with positive MRI and EEG findings. Mean T2 relaxation time was calculated in each ROI, and an average was derived. Mean and Standard Deviation (SD) were calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. To determine the association of T2 relaxometry values in the study and control groups, an unpaired t-test was used. Results: The mean age of participants was 25.14±9.35 years (ranging from 9 to 51 years). The male-to-female ratio was 1.25:1. Hippocampal atrophy (32 out of 36 cases) and T2 signal alteration (30 out of 36 cases) were the most commonly identified features in Mesial Temporal Sclerosis (MTS). MRI without T2 relaxometry had a sensitivity of 94%. In two cases, where only mild hippocampal atrophy was identified in the conventional MRI sequence, making the diagnosis dubious, T2 relaxometry revealed increased T2 relaxation time in the head of the hippocampus and guided a proper diagnosis. EEG was able to lateralise seizures in 8 out of 13 right MTS cases (61.5%), 10 out of 17 left MTS cases (58.9%), and 5 out of 6 cases of bilateral MTS (83%). Conclusion: T2 relaxometry allows quantification of hippocampal signal intensity, allowing the detection of even subtle changes in signal intensity that are difficult to perceive by visual assessment. [ABSTRACT FROM AUTHOR]

Background: Temporal lobe epilepsy is the most common type of focal onset seizure. Focal onset seizure with impaired awareness, previously known as complex partial seizure (CPS), account for 18–40% of all seizure types. Hippocampal sclerosis (HS) is the most common cause of temporal lobe epilepsy, which produces focal onset seizure with impaired awareness. It may be detected in MRI visually, but bilateral abnormalities are better identified using volumetric analysis. We aimed to compare hippocampal volume in patients with focal onset seizure with impaired awareness visually and quantitatively. Methodology: This cross-sectional study includes clinically diagnosed cases of 56 focal onset seizure with impaired awareness undergoing MRI at a tertiary teaching hospital in the southern part of India for a duration of 18 months from February 2018 to August 2019. Results: Out of 53 patients studied using 1.5 T MRI brain with seizure protocols, hippocampal atrophy was identified visually in 13 (24.5%) on the right side, 9 (16.98%) on the left side, and in 6 (11.32%) bilaterally. However, with volumetry, hippocampal atrophy (not taking T2 signal change) was detected in 15 (28.30%) on the right side, 10 (18.86%) on the left side, and in 7 (13.20%) bilaterally. Hippocampal volumes between ipsilateral and contralateral seizure focus were found to have no significant difference (p-0.84). Conclusions: Though visual analysis is efficient in the diagnosis of pathology, MR volumetry may be used as an expert eye in cases of subtle volume loss. [ABSTRACT FROM AUTHOR]

Background: We aimed to study the radiological and epilepsy outcomes of children with multiple neurocysticercosis (NCC) and the relationship with hippocampus volume. Study Design: Observational study. Materials and Methods: Children between 5 and 18 years of age with NCC lesions and completed more than 2-year follow-up were enrolled. Magnetic resonance imaging (MRI) brain with a predefined protocol was done as per clinical indication, and bilateral hippocampi volume was measured with a region of interest-based manual method. Proportion of children who had radiological resolution of lesions, proportion of children who were seizure-free for at least 3 months after antiepileptic drugs withdrawal, and mean hippocampi volume were calculated. Results: During the study period, 229 children followed up in pediatric NCC clinic were enrolled, the mean age was 10.5 ± 3 years, and 129 (56%) were boys. A total of 159 (65%) children had single-lesion NCC, and 79 (35%) had multiple lesion (> 2) NCC. Resolution of lesions was seen in 8% children with multiple NCC, significantly less as compared to the single NCC group (8% vs. 27%, P = 0.006). Multiple-lesion NCC group had a higher rate of calcification as compared to children with a single lesion (66% vs. 47%, P = 0.008). Twenty-nine (37%) children with multiple-lesion NCC were seizure free for at least 3 months after antiepileptic drug withdrawal. Mean combined hippocampal volume in children with single-lesion NCC was 2.96 (0.62) mL and multiple-lesion NCC was 2.88(0.43) mL. Conclusion: Children with multiple-lesion NCC have lower resolution, and higher calcification during follow-up in comparison to single-lesion NCC. Frequency of children who remained seizure-free 3-month post AED withdrawal was similar in single- and multiple-lesion groups. [ABSTRACT FROM AUTHOR]

• Rehabilitation related improvements in memory, anxiety and quality of life were sustained at 6 months. • Culturally tailored psychoeducation was beneficial. • Lack of understanding on the role of cognition in epilepsy is prevalent in patients and caregivers. • Neuropsychology referral should be made at the time of diagnosis. • Standard deviation cut-off may be an adequate index of meaningful change. Neuropsychological Rehabilitation (NR) helps manage cognitive deficits in epilepsy. As internationally developed programs have limited applicability to resource-limited countries, we developed a program to bridge this gap. This 6-week caregiver-assisted, culturally suitable program has components of (1) psychoeducation, (2) compensatory training, and, (3) cognitive retraining and is called EMPOWER (Indig e nized Ho m e Based Attention and Memory Rehabilitation P rogram f o r Adult Patients w ith Drug R e f r actory Epilepsy). Its efficacy needs to be determined. We carried out an open-label parallel randomized controlled trial. Adults aged 18–45 years with Drug Refractory Epilepsy (DRE), fluency in Hindi and or English, with impaired attention or memory (n = 28) were randomized to Intervention Group (IG) and Control Group (CG). The primary outcomes were objective memory (Auditory Verbal Learning Test), patient and caregiver reported everyday memory difficulties (Everyday Memory Questionnaire-Revised), number of memory aids in use, depression (Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale) and quality of life (Quality of Life in Epilepsy-31). Intention to treat was carried out for group analysis. In the absence of norms necessary for computing Reliable Change Indices (RCIs), a cut-off of +1.0 Standard Deviation (SD) was utilized to identify clinically meaningful changes in the individual analysis of objective memory. A cut-off of 11.8 points was used for quality of life. Feedback and program evaluation responses were noted. The majority of the sample comprised DRE patients with temporal lobe epilepsy who had undergone epilepsy surgery. Group analysis indicated improved learning (p = 0.013), immediate recall (p = 0.001), delayed recall (p < 0.001), long-term retention (p = 0.031), patient-reported everyday memory (p < 0.001), caregiver-reported everyday memory (p < 0.001), anxiety (p = 0.039) and total quality of life (p < 0.001). Individual analysis showed improvement in 50 %, 64 %, 71 %, 57 %, and 64 % of patients on learning, immediate recall, delayed recall, long-term retention, and total quality of life respectively. Despite improvements, themes indicative of a lack of awareness and understanding of cognitive deficits were identified. Overall, the program was rated favorably by patients and caregivers alike. NR shows promise for patients with DRE, however larger studies are warranted. The role of cognition in epilepsy needs to be introduced at the time of diagnosis to help lay the foundation for education and acceptance. [ABSTRACT FROM AUTHOR]

Objective: To study the trends for pediatric epilepsy surgery between 2000 and 2014 in a tertiary epilepsy surgery center in India in order to gain a lower‐ and middle‐income country (LMIC) perspective. Methods: Children aged <18 years and undergoing epilepsy surgery were divided into three groups based on the year that they underwent surgery—group 1: year 2000–2004; group 2: year 2005–2009; and group 3: year 2010–2014. Data including the rate of surgery, type of surgery, and duration of epilepsy before referral were analyzed from the medical records and compared. Results: Between 2000 and 2014, 463 pediatric epilepsy surgeries were performed. The proportion of pediatric epilepsy surgeries showed an increasing trend—218 (total 510 surgeries, 42.74%) in group 3, compared with 115 (total 375 surgeries, 30.66%) in group 1 and 130 (total 466 surgeries, 27.9%) in group 2. A significant decrease in the age at evaluation and duration of epilepsy before referral was noted between 2000 and 2014, particularly in patients belonging to the lowest income group. There was a two‐fold increase in the number of extratemporal surgeries over time. The proportion of children undergoing surgery for benign tumors, cortical malformations, and gliosis/atrophy showed an upward trend while that for mesial temporal sclerosis did not show an increase. Significance: Promising trends in pediatric epilepsy surgery were noted with increasing number of surgeries and decreasing age at presurgical evaluation. Seen from an LMIC perspective, this reflects an evolution in the practice of pediatric epilepsy surgery, mirroring trends in high‐income countries. [ABSTRACT FROM AUTHOR]

Objective: To apply the new IC-CoDE cognitive diagnostic taxonomy (Norman et al., 2020) to a large cohort of people with temporal lobe epilepsy (TLE) in India. The IC-CoDE taxonomy of cognitive diagnoses for 1,409 Englishspeaking adults with TLE from seven epilepsy centres in the U.S. has been published (McDonald et al., 2022). Initial results suggest that the IC-CoDE produces stable cognitive phenotypes across centres; however, its international applicability, including the suggested impairment cut-off needs to be considered across cultures and languages to avoid misclassification. The aim of this study was to apply the IC-CoDE to a population, outside of the U.S., diverse in language representation (i.e., bi/multi-lingual), assessment tools, normative data, and educational and cultural backgrounds to determine whether the same cognitive phenotypes and their relative frequencies would emerge. Participants and Methods: Data from 549 adults with TLE (mean age=27.14 (8.04), 60.47% males) from a tertiary referral hospital in Mumbai, India who had undergone a comprehensive neuropsychological evaluation (minimum two tests in at least 4 of the 5 cognitive domains: memory, language, executive function, attention/processing speed and visuospatial) were analysed using the ICCoDE criteria. The base rate of impairment for individual tests was calculated using a cutoff of 1.5 standard deviations (S.D.) below the normative mean. The cognitive diagnostic criteria were applied, and the distribution and base rate of cognitive phenotypes was compared to the published taxonomy data from the U.S. (McDonald et al., 2022). Results: In comparison to the U.S. cohort, the India group was relatively younger, lower in the education level, had a younger age at seizure onset and a shorter duration of the epilepsy. Application of the IC-CoDE taxonomy using a 1.5 S.D. cutoff revealed an Intact cognitive profile in 48% of patients, Single Domain impairment in 32%, Bi Domain impairment in 15% and Generalised impairment in 5%. These findings were mostly comparable to percentages reported in the U.S. cohorts with Intact profile (47%; c2= 0.158, p=0.690), Single Domain (29%; c2= 46.26, p<0.01), Bi Domain (16%; c2= 0.298, p=0.585) and Generalised (8%; c2= 5.347, p=0.021) impairment. However, the most common impairment in the Single Domain group for the bi/multilingual India population was Memory (38%) followed by Attention (20%) and then Language (13%), diverging from the distribution in the U.S. data with maximum impairment in Language (49%) followed by Memory (32%) in the Single Domain Group. Conclusions: These findings demonstrate that the IC-CoDE can be applied internationally, and the broad taxonomy of cognitive diagnosis holds even in a culturally, linguistically diverse population. Differences in rates of impairments across specific domains emerged with language relatively preserved in the India bi/multilingual population, and memory more frequently impaired than observed in the multi-centre U.S. sample. These findings may reflect differences in demographics, rates of bi/multilingualism, normative data, language tools, or underlying neuropathology, which should be further explored to determine their impact on cognitive profiles. [ABSTRACT FROM AUTHOR]

Background & Objectives: Depression, anxiety and suicide are the main psychiatric comorbidities which are more prevalent among persons with epilepsy (PWE). This study aims to determine the prevalence of depression, anxiety and suicidal ideation/behaviour in PWE and to correlate their clinical profile with psychiatric comorbidities in a population in North India. Methods: This study was conducted at Pt. BD Sharma PGIMS, Rohtak Haryana among PWE attending outpatient clinic at the Department of Neurology. A total of 100 eligible PWE were included in this study. The demographic and clinical history was documented. All patients filled up the Hospital anxiety and depression scale (HADS) and Columbia-suicide severity rating scale (C-SSRS) questionnaire. Results: The prevalence of depression and anxiety among PWE was found to be 60% and 70% respectively and the prevalence of suicidal ideation and suicidal behaviour was 42% and 3% respectively among PWE. Female gender, longer duration of epilepsy, higher seizure frequency, temporal lobe epilepsy, polytherapy, uncontrolled epilepsy and drug resistant epilepsy were found to be positively correlated with these psychiatric comorbidities. Conclusion: This study shows that the prevalence of depression, anxiety and suicidal ideation/behaviour is high among PWE in Haryana, North India. PWE should be screened for these psychiatric comorbidities to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to investigate the utility of 3-Tesla MRI in cases of partial onset epilepsy with a previous normal CT scan. We confer the results of MRI findings in 50 cases of partial onset epilepsy from 2014–16 using 3-Tesla MRI. Materials and methods Study was conducted on 50 patients of partial onset epilepsy from April 2014 to March 2016 from a tertiary health centre in Rajasthan, India using 3-Tesla Philips Ingenia scanner. All patients of partial epilepsy having a normal CT scan were included and underwent MRI brain with epilepsy protocol. Patients with isolated generalized, myoclonic or absence seizure types were excluded. Those having inflammatory or granulomatous lesions on MRI were excluded from the analysis. Results There were a total of 50 patients (28 males), mean age of onset was 20.21 years, ranging from 7 to 50 years; commonest presentation was that of focal seizures combined with multiple seizure types (60%). Out of these patients, MRI could localize a structural lesion in 64% cases who were having no corresponding abnormalities on a CT scan with a sensitivity of 86.7% and specificity of 73.5%. The detected abnormalities were Mesial temporal sclerosis in 30% (n = 15), Vascular malformation 10% (n = 5), Cortical malformation 8% (n = 4), Encephalitis 8% (n = 4), Neurodegenerative 4% (n = 8), cerebritis 2% (n = 1) and paraganglioma 2% (1). Conclusion In evaluation of structural lesions in cases of partial onset epilepsy, 3-Tesla MRI should be a prerequisite. Detection of focal structural lesion may help in planning epilepsy surgery for some of these candidates in future. [ABSTRACT FROM AUTHOR]

Objective: Although rare, temporal encephalocele is an important causative agent in surgically remediable drug-refractory epilepsy. The ideal treatment for temporal encephalocele remains unclear with a variety of resective surgeries recommended. Here, we analyse patient data on temporal encephalocele with a view to highlighting diagnostic clues and management strategies., Methods: Comprehensive databases at Deenanath Mangeshkar Hospital, Pune from January 2015 to June 2019 were reviewed for this observational study. Of 107 temporal lobe epilepsy surgery patients, nine individuals with temporal encephalocele were identified, who formed the study cohort. Their clinical, neuropsychological, EEG, imaging and long-term outcome data were analysed., Results: The study cohort consisted of seven males and two females with a mean age of 22 years. Epilepsy onset age varied from 4.5 to 19 years. Seven patients had focal non-motor seizures with impaired awareness, while two patients had focal motor seizures. Temporal encephalocele detection by MRI was reported in only two patients, and was missed in seven individuals. Three patients underwent standard anterior temporal lobectomy while the remaining six underwent resection of the temporal encephalocele with surrounding temporal pole. Eight patients showed Engel Class I outcome and one showed Class IIa outcome after a mean follow-up duration of 27 months (17-44 months). Histopathology confirmed gliosis in seven, hippocampal sclerosis type I in one and suspicious dyslamination with prominent gliosis in one patient. Six of eight patients reported an improvement in their psychological state (mood, anxiety and motivation) over time., Significance: A careful review of MRI in patients with temporal lobe epilepsy is necessary, followed by investigations for the presence of an encephalocele. When temporal lobe epilepsy is associated with encephalocele, tailored resection of the encephalocele and the surrounding temporal pole, sparing mesial temporal structures, demonstrates excellent long-term clinical and neuropsychological outcome.

Background: Surgical management of intractable epilepsies is currently an established mode of therapy in various clinical settings. Aims: To retrospectively evaluate the neuropathological findings in both temporal and extratemporal lobe resections in such patients. Materials and Methods: The study included resected specimens from patients with intractable epilepsy managed at a tertiary care hospital of India, during a 10-year period (1995-2004). Results: A total of 153 patients, with mean age of 19.4 years and male predominance (73.2%) were included in the study. Overall, there was a predilection for the temporal lobe (73.2%), while 41 cases were extratemporal in location. On histopathology, mesial temporal sclerosis (MTS) (24.8%) was the commonest lesion, followed by tumors (19.6%) and isolated focal cortical dysplasia (FCD - 15.11%). Other less common findings included Rasmussen encephalitis, non-specific gliosis and vascular malformations. In addition, 20.9% (32 cases) had dual lesions, majority of which included FCD with ganglioglioma (15 cases) or with dysembryoplastic neuroepithelial tumor (12 cases). In the temporal lobe, neoplasms and dual lesions formed the majority (apart from MTS), unlike dual lesions followed by neoplasms and FCD, in the extratemporal location. Conclusion: This series demonstrates that most patients with chronic intractable epilepsy have significant histopathological findings and highlights the neuropathological spectrum of such lesions, in the Indian context. This was similar to that reported from the West, but different from the single Indian series available in the literature. Further, the overall profile of temporal lobe lesions was not different from the Extratemporal ones. [ABSTRACT FROM AUTHOR]

We studied the anatomical correlates of reflex hot water epilepsy (HWE) using multimodality investigations viz. magnetic resonance imaging (MRI), electroencephalography (EEG), and single photon emission computed tomography (SPECT). Five men (mean age: 27.0 ± 5.8 years) with HWE were subjected to MRI of brain, video-EEG studies, and SPECT scan. These were correlated with phenotypic presentations. Seizures could be precipitated in three patients with pouring of hot water over the head and semiology of seizures was suggestive of temporal lobe epilepsy. Ictal SPECT showed hyperperfusion in: left medial temporal — one, left lateral temporal — one, and right parietal — one. Interictal SPECT was normal in all five patients and did not help in localization. MRI and interictal EEG was normal in all the patients. The clinical and SPECT studies suggested temporal lobe as the seizure onset zone in some of the patients with HWE. [ABSTRACT FROM AUTHOR]

The article focuses on the study related to the malformations of cortical development (MCD) which include the group of central nervous system disorders in children with developmental delay with epilepsy. It mentions that the classification schemes are introduced on the steps in neural development, with neuronal proliferation, migration and differentiation.

The article focuses on the study related to the malformations of cortical development (MCDs) as the common and important causes of childhood drug-resistant epilepsy. It mentions that the MCDS come from alterations in the progenitor proliferation, neuronal migration, and differentiation. It states that Incomplete Hippocampal Inversion Incomplete hippocampal inversion (IHI) is called hippocampal malrotation.

The article reports on a retrospective study which analyzed the results of neuropathological examinations in 153 patients who have undergone surgery for chronic epilepsy in an Indian neurosurgical center. The study showed that 75 percent of patients have temporal lobe epilepsy while 33 percent have mesial temporal sclerosis (MTS). Also, lesions were found that represent a mix of developmental malformations.