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Epilepsy Associated with Temporal Pole Encephaloceles

An Unrecognized Manifestation of Idiopathic Intracranial Hypertension?

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Abstract

Purpose

We hypothesized that epilepsy associated with temporal pole encephaloceles (ETPE) could be the consequence and an unrecognized manifestation of idiopathic intracranial hypertension (IIH). To test this hypothesis in patients with ETPEs we evaluated: 1) the frequency of two radiological signs of IIH and 2) whether these patients develop over time clinical manifestations suggestive of elevated intracranial pressure (ICP).

Methods

Case-control study comparing two cardinal radiological signs of IIH pituitary gland height (PGH) and the diameter of the two optic nerve sheaths (ONS) between 29 patients with ETPEs (TPE group) and 29 patients with focal epilepsy of other etiologies (control group), adjusted by age, sex, body mass index (BMI), age at epilepsy onset and epilepsy duration. Analysis was performed using conventional and ordinal logistic regression. The measurements in both groups were compared with validated radiological criteria of IIH.

Results

Of the patients 17 (63%) in the TPE group had all three measurements over the cut-off values for IIH, while no patients in the control group had all three findings. The TPE group patients had lower PGH (3.2 ± 1.0 mm vs. 4.9 ± 1.3 mm, p < 0.001) and larger diameter of ONS than controls (p < 0.001), being similar to validated data of IIH. No patient with TPE had clinical manifestations of elevated ICP (mean follow-up 15.1 ± 11.7 years).

Conclusion

Patients with ETPEs frequently had radiological signs of IIH while not developing typical manifestations of elevated ICP over time. In this way, ETPEs could be an unrecognized manifestation of IIH, and temporal lobe seizures the only clinical expression of this epilepsy syndrome.

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References

  1. Abou-Hamden A, Lau M, Fabinyi G, Berkovic SF, Jackson GD, Mitchell LA, Kalnins R, Fitt G, Archer JS. Small temporal pole encephaloceles: a treatable cause of “lesion negative” temporal lobe epilepsy. Epilepsia. 2010;51:2199–202.

    Article  Google Scholar 

  2. Toledano R, Jiménez-Huete A, Campo P, Poch C, García-Morales I, Gómez Angulo JC, Coras R, Blümcke I, Álvarez-Linera J, Gil-Nagel A. Small temporal pole encephalocele: a hidden cause of “normal” MRI temporal lobe epilepsy. Epilepsia. 2016;57:841–51.

    Article  Google Scholar 

  3. Gasparini S, Ferlazzo E, Pustorino G, Ascoli M, Cianci V, Sueri C, Calabrò S, Campello M, Africa E, Gangemi A, Versace P, Aguglia U. Epileptogenic role of occult temporal encephalomeningocele: Case-control study. Neurology. 2018;90:e1200–3.

    Article  Google Scholar 

  4. Saavalainen T, Jutila L, Mervaala E, Kälviäinen R, Vanninen R, Immonen A. Temporal anteroinferior encephalocele: an underrecognized etiology of temporal lobe epilepsy? Neurology. 2015;85:1467–74.

    Article  Google Scholar 

  5. Urbach H, Jamneala G, Mader I, Egger K, Yang S, Altenmüller D. Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing: a consequence of idiopathic intracranial hypertension? Neuroradiology. 2018;60:51–60.

    Article  CAS  Google Scholar 

  6. Campbell ZM, Hyer JM, Lauzon S, Bonilha L, Spampinato MV, Yazdani M. Detection and characteristics of temporal encephaloceles in patients with refractory epilepsy. AJNR Am J Neuroradiol. 2018;39:1468–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Hoffmann J, Huppertz HJ, Schmidt C, Kunte H, Harms L, Klingebiel R, Wiener E. Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia. 2013;33:1075–84.

    Article  Google Scholar 

  8. Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, McDermott MP; NORDIC Idiopathic Intracranial Hypertension Study Group. The idiopathic intracranial hypertension treatment trial: clinical profile at baseline. JAMA Neurol. 2014;71:693–701.

    Article  Google Scholar 

  9. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38:1–211.

    Google Scholar 

  10. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013.

    Google Scholar 

  11. Pérez MA, Bialer OY, Bruce BB, Newman NJ, Biousse V. Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension. J Neuroophthalmol. 2013;33:330–7.

    Article  Google Scholar 

  12. Paule E, Freiman TM, Strzelczyk A, Reif PS, Willems LM, Wagner M, Zöllner JP, Rosenow F. Characteristics of bilateral versus unilateral temporal encephalocele-associated epilepsy. Seizure. 2019;71:13–9.

    Article  Google Scholar 

  13. Lenck S, Radovanovic I, Nicholson P, Hodaie M, Krings T, Mendes-Pereira V. Idiopathic intracranial hypertension: the venoglympathic connections. Neurology. 2018;91:515–22.

    Article  Google Scholar 

  14. Bruce BB, Kedar S, Van Stavern GP, Corbett JJ, Newman NJ, Biousse V. Atypical idiopathic intracranial hypertension: normal BMI and older patients. Neurology. 2010;74:1827–32.

    Article  CAS  Google Scholar 

  15. Hartmann AJ, Soares BP, Bruce BB, Saindane AM, Newman NJ, Biousse V, Peragallo JH. Imaging Features of Idiopathic Intracranial Hypertension in Children. J Child Neurol. 2017;32:120–6.

    Article  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Epilepsy Unit, Department of Neurology, Hospital Ruber Internacional, c/La Masó, 38, 28034, Madrid, Spain

    Javier Martinez-Poles, Rafael Toledano, Irene García-Morales & Antonio Gil-Nagel

  2. Epilepsy Unit, Department of Neurology, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain

    Javier Martinez-Poles & Irene García-Morales

  3. Epilepsy Unit, Department of Neurology, Hospital Ramón y Cajal, Madrid, Spain

    Rafael Toledano, Ángel Aledo-Serrano & Carla Anciones

  4. Department of Neurology, Hospital Ruber Internacional, Madrid, Spain

    Adolfo Jiménez-Huete

  5. Department of Basic Psychology, Autonoma University of Madrid, Madrid, Spain

    Pablo Campo

  6. Department of Radiology, Hospital Ruber Internacional, Madrid, Spain

    Juan Álvarez-Linera

Authors
  1. Javier Martinez-Poles
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  2. Rafael Toledano
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  3. Adolfo Jiménez-Huete
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  4. Irene García-Morales
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  5. Ángel Aledo-Serrano
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  6. Carla Anciones
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  7. Pablo Campo
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  8. Juan Álvarez-Linera
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  9. Antonio Gil-Nagel
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Corresponding author

Correspondence to Javier Martinez-Poles.

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Conflict of interest

J. Martinez-Poles, R. Toledano, A. Jiménez-Huete, I. García-Morales, Á. Aledo-Serrano, C. Anciones, P. Campo, J. Álvarez-Linera and A. Gil-Nagel declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived due to the retrospective nature of the study. Consent for publication was waived for this anonymized retrospective study.

Additional information

Javier Martinez-Poles and Rafael Toledano contributed equally.

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Martinez-Poles, J., Toledano, R., Jiménez-Huete, A. et al. Epilepsy Associated with Temporal Pole Encephaloceles. Clin Neuroradiol 31, 575–579 (2021). https://doi.org/10.1007/s00062-020-00969-0

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  • DOI: https://doi.org/10.1007/s00062-020-00969-0

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