Reduction of frontal neocortical grey matter associated withaffective aggression in patients with temporal lobe epilepsy: anobjective voxel by voxel analysis of automatically segmented MRI

摘要

BACKGROUND—Interictal episodes of aggression are often reported in patients with epilepsy. Some have characteristics of what has been referred to as episodic dyscontrol or intermittent explosive disorder (IED). Although structural brain abnormalities are thought to play a part in the pathophysiology of aggression, there are few in vivo studies of structural cerebral changes in patients with epilepsy and aggression. Using quantitative MRI, subtle structural brain abnormalities can be investigated in subgroups of patients with both epilepsy and episodes of affective aggression.
METHODS—After automated segmentation of cerebral grey matter from T1 weighted MRI, the objective technique of statistical parametric mapping (SPM) was applied to the analysis of 35 control subjects, 24 patients with temporal lobe epilepsy (TLE) with a history of repeated, interictal episodes of aggression, and 24 patients with TLE without episodes of aggression. Both TLE patient groups were compared with each other and with the control subjects on a voxel by voxel basis for increases anddecreases of grey matter.
RESULTS—The patientswith TLE with aggressive episodes had a decrease of grey matter, mostmarkedly in the left frontal lobe, compared with the control group andwith patients with TLE without aggressive episodes.
CONCLUSION—Thesefindings suggest that a reduction of frontal neocortical grey mattermight underly the pathophysiology of aggression in TLE. These voxel byvoxel comparisons can guide further in vivo studies into aggression.