Effect of Patient Sex on White Matter Alterations in Unilateral Medial Temporal Lobe Epilepsy with Hippocampal Sclerosis Assessed by Diffusion Tensor Imaging

K.K. Oguz; I. Tezer; E. Sanverdi; A.C. Has; B. Bilginer; A. Dolgun; S. Saygi

doi:10.3174/ajnr.A3328

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure.
The TBSS (family-wise error–corrected threshold-cluster extend voxel P maps) reveal regions of significantly reduced FA (red) and increased MD (blue) in female patients with right HS (A), male patients with right HS (B), female patients with left HS (C), and male patients with left HS (D) compared with sex-matched and age-matched control groups at P < .05. E, The TBSS of women vs men within the whole control group show that men have few voxels with lower FA (red) and higher MD (blue) than women. FA skeleton that represents the center of the main WM tracts is shown in green on mean FA map.

Tables

Figures

View popup

Table 1:

Demographic and clinical features

Group	No of Patients (n)	Age Range; Mean Age ± SD (y)	Duration of Epilepsy; Mean ± SD (y)	History of Risk Factors (n)	Unilateral Ipsilateral Interictal EEG Abnormality (n)	Bilateral Interictal EEG Abnormality (n)
Women with right HS	12	19–47; 30.58 ± 9.78; ^{^a}P = .89; ^{^b}P = .94; ^{^d}P = .73	1–38; 20.41 ± 10.69; ^{^b}P = .98; ^{^d}P = .47	FS: 9; FH: 4; trauma: 1; meningitis: 1; none: 2	12	None
Men with right HS	10	17–42; 30.9 ± 8.72; ^{^a}P = .93; ^{^b}P = .94; ^{^e}P = .55	6–41; 20.55 ± 12.12; ^{^b}P = .98; ^{^e}P = .30	FS: 5; FH: 3; trauma: 2; none: 3	7	3
Women with left HS	12	23–37; 29.5 ± 4.21; ^{^a}P = .81; ^{^c}P = .20; ^{^d}P = .73	16–28; 20.44 ± 5.10; ^{^c}P = .13; ^{^d}P = .47	FS: 7; FH: 4; trauma: 3; none: 4	11	1
Men with left HS	10	22–42; 32.7 ± 7.02; ^{^a}P = .69; ^{^c}P = .20; ^{^e}P = .55	10–36; 25.60 ± 8.42; ^{^c}P = .13; ^{^e}P = .30	FS: 4; FH: 4; trauma: 5; perinatal insult: 2; none: 1	10	None

Note:—Lateralization of HS on MR imaging and electrophysiologic ictal findings, and unilateral or bilateral presence of interictal EEG abnormalities of the patients are summarized.
FH indicates family history, FS, febrile seizure.
↵a P values for matched control participants.
↵b P values for women with right HS and men with right HS.
↵c P values for women with left HS and men with left HS.
↵d P values for women with right HS and women with left HS.
↵e P values for men with right HS and men with left HS.

View popup

Table 2:

Number and AI of voxels with statistically significant decreased FA and MD

Group	No. of Voxels with Significant Change (FA/MD)	AI of Voxels (L−R/L+R × 100) (FA/MD)
Women with right HS	24,727/16,926	−41.4/−29.2
Men with right HS	14,013/5389	−19.7/−62.2
Women with left HS	5459/5458	32.9/41.6
Men with left HS	27,332/4764	10.9/22.04

View popup

Table 3:

Summary of TBSS analysis

Brain Region	FR-HS		MR-HS		FL-HS		ML-HS
Brain Region	FA_p/FA_c	MD_p/MD_c	FA_p/FA_c	MD_p/MD_c	FA_p/FA_c	MD_p/MD_c	FA_p/FA_c	MD_p/MD_c
R cingulum	0.23/0.28	0.85/0.82	0.21/0.29	−	0.31/0.35	−	−	1.00/0.89
L cingulum	−	0.84/0.73	−	−	0.24/0.34	−	0.30/0.35	1.00/0. 73
R ATWM;ILF	0.23/0.40	0.88/0.79	0.25/0.34	0.87/0.79	0.32/0.37	0.83/0.72	0.19/0.24	−
L ATWM;ILF	0.34/0.40	0.86/0.78	−	−	0.31/0.36	0.88/0.74	0.22/0.28	0.91/0.82
R fornix	0.29/0.33	1.45/1.33	−	1.69/1.48	0.34/0.39	1.70/1.32	0.28/0.44	1.87/1.57
L fornix	−	−	0.31/0.38	−	0.32/0.41	1.84/1.39	0.34/0.44	1.90/1.79
R uncinate fasciculus	0.30/0.43	0.84/0.79	0.36/0.45	0.84/0.77	−	−	−	−
L uncinate fasciculus	−	−	−	−	0.47/0.51	0.80/0.75	0.32/0.39	0.87/0.79
CC genu	0.36/0.59	0.76/0.68	0.64/0.78	0.88/0.70	0.38/0.49	0.78/0.74	0.40/0.56	1.07/0.77
CC body	0.44/0.52	1.12/0.92	0.38/0.51	1.69/1.29	−	−	0.46/0.68	1.09/0. 81
R ALIC	0.49/0.55	0.79/0.71	0.26/0.29	0.74/0.68	0.65/0.76	0.72/0.66	0.54/0.65	0.71/0.67
R PLIC	0.68/0.72	0.71/0.62	0.66/0.72	−	0.59/0.66	0.73/0.68	−	−
L ALIC	−	−	−	−	0.57/0.66	0.75/0.65	0.51/0.59	1.00/0.68
L PLIC	−	−	0.65/0.69	−	0.60/0.69	0.73/0.66	−	−
R external capsule	0.34/0.43	0.74/0.63	0.39/0.46	−	−	−	0.30/0.38	−
L external capsule	0.41/0.46	0.78/0.74	0.43/0.47	−	0.39/0.45	0.79/0.71	0.34/0.42	0.73/0.66
R thalamus	0.32/0.36	0.86/0.75	0.36/0.40	0.81/0.66	0.36/0.43	0.70/0.64	0.44/0.51	0.79/0.75
L thalamus	0.31/0.35	0.75/0.70	0.29/0.34	0.71/0.69	0.31/0.37	0.88/0.71	0.30/0.36	1.00/0.73
R IFOF	0.41/0.50	−	0.29/0.37	0.79/0.72	−	−	0.30/0.46	−
L IFOF	−	−	0.30/0.35	−	0.38/0.43	0.83/0.75	0.46/0.56	0.80/0.75
R acoustic radiation	0.45/0.49	0.79/0.69	−	−	−	−	−	−

Note:—The mean FA and MD (x10⁻³ mm²/s) values of significant clusters in patients along with those of control participants and corresponding WM regions are derived according to the Johns Hopkins University WM tractography atlas and the International Consortium for Brain Mapping DTI-81 WM atlas.
ATWM indicates anterior temporal lobe white matter; ALIC, anterior limb of the internal capsule; PLIC, posterior limb of the internal capsule; CC, corpus callosum; FA_p/FA_c, fractional anisotropy of the patients/fractional anisotropy of the controls; FL-HS, female patients with left HS; FR-HS, female patients with right HS; IFOF, inferior fronto-occipital fasciculus; ILF, inferior longitudinal fasciculus; L, left; MD_p/MD_c, mean diffusivity of the patients/mean diffusivity of the controls; ML-HS, male patients with left HS; MR-HS, male patients with right HS; R, right; TBSS, tract-based spatial statistics.