White-matter diffusion abnormalities in temporal-lobe epilepsy with and without mesial temporal sclerosis.

Although epilepsy is considered a grey-matter disorder, changes in the underlying brain connectivity have important implications in seizure generation and propagation. Abnormalities in the temporal and extratemporal white matter of patients with temporal-lobe epilepsy (TLE) and mesial temporal sclerosis (MTS) have previously been identified. Patients with TLE but without MTS often show a different course of the disorder and worse surgical outcome than patients with MTS. The purpose of this study was to determine if said white-matter abnormalities are related to the presence of MTS or if they are also present in non-lesional TLE. Seventeen patients with TLE and MTS (TLE+uMTS), 13 patients with non-lesional TLE (nl-TLE) and 25 controls were included in the study. Diffusion tensor imaging (DTI) was used to assess tract integrity of the fornix, cingulum, external capsules and the corpus callosum. The white-matter abnormalities seen in the fornix appear to be exclusive to patients with MTS. Although the cingulum showed an abnormally high overall diffusivity in both TLE groups, its anisotropy was decreased only in the TLE+uMTS group in a pattern similar to the fornix. The frontal and temporal components of the corpus callosum, as well as the external capsules, demonstrated reduced anisotropy in TLE regardless of MTS. While some white-matter bundles are affected equally in both forms of TLE, abnormalities of the bundles directly related to the mesial temporal structures (ie, the fornix and cingulum) appear to be unique to TLE+uMTS.