Association between structural abnormalities and fMRI response in the amygdala in patients with temporal lobe epilepsy

Objective: The goal of this study was to investigate whether dysplastic amygdalae show an impaired response as revealed by functional MRI (fMRI). Methods: A fearful face fMRI paradigm using video sequences, as we have recently applied, was used in 25 patients with temporal lobe epilepsy (TLE): 24 had mesial TLE (14 right-, nine left-sided, one bilateral); one left lateral neocortical TLE. T1-, T2-weighted and fluid attenuated inversion recovery (FLAIR) MRI sequences were assessed for the detection and categorisation of structural amygdalar abnormalities according to size and MR signal intensity. Of the 25 patients, five patients had probable dysplastic amygdala (pDA): two right- and three left-sided. Results: A fearful face paradigm led to significant amygdalar activation in all but one patient (p < 0.05). In 15 (60%) of the patients amygdalar activation was found contralateral and in four (16%) ipsilateral to the side of seizure onset. Bilateral amygdalar activation was registered in five (20%) patients. In two patients with right-sided and one with left-sided pDA, fMRI activation was observed only in the contralateral amygdala. In two out of three patients with left-sided pDA we found significant ipislateral amygdalar fMRI-responses. Conclusion: Unilateral pDA does not necessarily affect the amygdalar fMRI BOLD-response. (C) 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.