Association of Amygdala and Hippocampus Volumes With Histopathological Diagnosis in Patients With Temporal Lobe Epilepsy

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Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Bigger or Smaller Amygdala? It Depends on the Epilepsy Cause (But This Study Needs More Patients)

This study found that in patients with temporal lobe epilepsy (TLE), the size of the amygdala can be either increased or decreased depending on the underlying cause of the epilepsy. In patients with hippocampal gliosis (HG), the amygdala tends to be enlarged, while in patients with hippocampal sclerosis (HS), it is often smaller. The study is limited by the small number of HG patients, potentially impacting the generalizability of results.

Possible Conflicts of Interest

Multiple authors disclosed receiving honoraria for lectures, consulting, or advisory boards from various pharmaceutical companies including Eisai, UCB, Desitin, Angelini, Jazz/GW Pharmaceuticals, Neuraxpharm, Precisis, Roche Diagnostics, Medscape, Tabuk, Teva, Zogenix, Biogen, Mbits, Lilly and Bayer. One author receives research funding from the Else-Kroener-Fresenius Foundation and Fraunhofer Society, while another has received research support from BIAL, Precisis, and UNEEG, and one from the German Federal Ministry of Education and Research and another from the German Research Foundation (DFG). These financial ties to pharmaceutical companies could potentially influence the research or interpretation of findings.

Identified Weaknesses

Small sample size for HG group

The sample size for the HG group is relatively small (9 patients), which makes it hard to be sure the findings would apply to a larger group of people.

Reliance on self-reported seizure diaries

Self-reported seizure diaries may not be the most accurate way to track how often seizures happen, as patients may not always remember or report every seizure.

Different reasons for sEEG implantation in HG and HS groups

It's hard to directly compare the sEEG results between patients with HG and HS because doctors decide whether to do sEEG based on different reasons for each group.

Limited generalizability to other TLE types

There are other conditions that affect the temporal lobe, like encephaloceles, that weren't included in this study, so the results might not apply to all types of temporal lobe epilepsy.

Rating Explanation

This study uses a well-established methodology (MRI volumetry) with appropriate controls for age, sex, and brain size. The findings of distinct volumetric patterns in HG vs HS patients are interesting and potentially clinically relevant. However, the small sample size of the HG group limits the generalizability of the findings. The disclosed conflicts of interest warrant close scrutiny but do not automatically invalidate the findings. Overall, the study is above average and adds to the field, but with clear areas that need further investigation.

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