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

摘要

BACKGROUND—Interictalepisodes of aggression are often reported in patients with epilepsy.Some have characteristics of what has been referred to as episodicdyscontrol or intermittent explosive disorder (IED). Althoughstructural brain abnormalities are thought to play a part in thepathophysiology of aggression, there are few in vivo studies ofstructural cerebral changes in patients with epilepsy and aggression.Using quantitative MRI, subtle structural brain abnormalities can beinvestigated in subgroups of patients with both epilepsy and episodesof affective aggression.
METHODS—Afterautomated segmentation of cerebral grey matter from T1 weighted MRI,the objective technique of statistical parametric mapping (SPM) wasapplied to the analysis of 35 control subjects, 24 patients withtemporal lobe epilepsy (TLE) with a history of repeated, interictalepisodes of aggression, and 24 patients with TLE without episodes ofaggression. Both TLE patient groups were compared with each other andwith 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.