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      Quantitative magnetic resonance imaging evidence for altered structural remodeling of the temporal lobe in West syndrome

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          To explore the structure–function relation of the temporal lobe in newly diagnosed West syndrome of unknown cause ( uWS).


          Quantitative magnetic resonance imaging (three‐dimensional [3D] structural MRI and diffusion tensor imaging [DTI]) was analyzed using voxel‐based morphometry ( VBM) and tract‐based spatial statistics ( TBSS) in 22 patients and healthy age‐matched controls. The electrophysiologic responsiveness of the temporal lobe was measured using the N100 auditory event‐related potential ( aERP) to a repeated 1,000 Hz tone. Neurocognitive function was assessed using the Bayley Scales of Infant Development, Second Edition ( BSIDII). Tests followed first‐line treatment with vigabatrin (17 patients) or high‐dose oral prednisolone (5 patients).


          Total temporal lobe volume was similar in patients and controls. Patients had a smaller temporal stem ( TS) (p < 0.0001) and planum temporale ( PT) (p = 0.029) bilaterally. TS width asymmetry with a larger right‐sided width in controls was absent in patients (p = 0.033). PT asymmetry was present in both groups, being larger on the right (p = 0.048). VBM gray matter volume was increased at the left temporal lobe (superior and middle temporal gyri, the peri‐rhinal cortex, and medial temporal lobe) (p < 0.005, family wise error‐corrected). VBM gray matter volume correlated with the duration of infantile spasms (Pearson's r = −0.630, p = 0.009). DTI metrics did not differ between patients and controls on TBSS. Mean BSIDII scores were lower (p < 0.001) and auditory N100 ERP attenuated less in patients than in controls (p = 0.002).


          The functional networking and white matter development of the temporal lobe are impaired following infantile spasms. Treatment may promote structural plasticity within the temporal lobe following infantile spasms, manifest as increased gray matter volume on VBM. It remains to be investigated further whether this predicts patients' long‐term cognitive difficulties.

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          Most cited references 40

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                Author and article information

                John Wiley and Sons Inc. (Hoboken )
                02 March 2015
                April 2015
                : 56
                : 4 ( doiID: 10.1111/epi.2015.56.issue-4 )
                : 608-616
                [ 1 ]Young Epilepsy SurreyUnited Kingdom
                [ 2 ] Department of Clinical NeurophysiologyGreat Ormond Street Hospital for Children NHS Trust LondonUnited Kingdom
                [ 3 ] Neurosciences UnitUniversity College London Institute of Child Health LondonUnited Kingdom
                [ 4 ] The Functional Imaging LaboratoryUniversity College London LondonUnited Kingdom
                [ 5 ] Department of NeuroradiologyGreat Ormond Street Hospital for Children NHS Trust LondonUnited Kingdom
                [ 6 ] RCS Unit of BiophysicsUniversity College London Institute of Child Health LondonUnited Kingdom
                [ 7 ] Department of NeurologyGreat Ormond Street Hospital for Children NHS Trust LondonUnited Kingdom
                [ 8 ] Department of Neurological SciencesUniversity of Vermont Burlington VermontU.S.A
                [ 9 ] Centre for Developmental Cognitive NeurosciencesUniversity College London LondonUnited Kingdom
                Author notes
                [* ]Address correspondence to Tangunu Fosi, UCL Institute of Child Health, 4‐5 Long Yard, London WC1N 3LU, U.K. E‐mail: sejjtfo@
                © 2015 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Pages: 9
                Funded by: Department of Health's NIHR Biomedical Research Centre
                Full‐Length Original Research
                Full‐length Original Research
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                April 2015
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