Liu, Rebecca Shook Ning;
(2004)
Investigation of secondary cerebral damage in epilepsy.
Doctoral thesis (Ph.D.), University College London (United Kingdom).
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Abstract
Background: This thesis addresses the relationship between epileptic seizures and progressive cerebral damage. It is the first longitudinal community-based quantitative magnetic resonance imaging (MRI) study to investigate the effect of seizures on the hippocampus, cerebellum and neocortex. Two key issues are addressed: whether epileptic seizures result in cerebral damage that can be detected with quantitative MRI, and identification of possible clinical risk factors. The work aims to enhance our understanding of the pathogenesis of cerebral damage in epilepsy and thus assist in the evaluation of neuroprotective strategies. Methods: One hundred and twenty-two patients with chronic active epilepsy, 68 patients with newly diagnosed seizures and 90 control subjects underwent two MRI brain scans 3.5 years apart. Automated and manual measurement techniques were used to identify global and regional changes in brain volume and alterations in hippocampal T2 relaxometry. Image subtraction of registered scans was used to identify diffuse and focal neocortical atrophy. Results: Baseline hippocampal, neocortical and cerebellar volumes were significantly reduced in the chronic epilepsy group compared with the newly diagnosed and control group. These differences could be attributed to a history of antecedent neurological insults. Rates of atrophy were similar amongst the three subject groups and primarily determined by age. A history of a prior neurological insult was associated with an increased rate of cerebral and cerebellar atrophy. Individuals with chronic epilepsy were at a significantly greater risk of developing focal and generalized neocortical volume loss. Risk factors included increased age and multiple antiepileptic drug exposure. Conclusion: Regional and global cerebral atrophy is not an inevitable consequence of seizures. Progressive hippocampal, cerebral and cerebellar atrophy in epilepsy is primarily the result of an initial neurological insult and age. However, subtle neocortical atrophy is common in epilepsy and may occur secondary to an underlying epileptogenic process, multiple antiepileptic drug exposure and individual genetic susceptibility.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D. |
| Title: | Investigation of secondary cerebral damage in epilepsy |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Thesis digitised by ProQuest. |
| Keywords: | (UMI)AAIU644093; Biological sciences; Epilepsy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10103441 |
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