Authors :
Presenting Author: Mehr Hakim, BS – Texas A&M University School of Medicine
Daniel Veltkamp, MD – University of Texas Southwestern Medical Center
Afsaneh Talai, MD – University of Texas Southwestern Medical Center, Dallas, Texas
Rationale:
Amygdala enlargement (AE) is an increasingly recognized MRI finding in mesial temporal lobe epilepsy (MTLE), particularly in patients without clear MRI lesions. While AE has been associated with later seizure onset, mood symptoms, and possible immune-mediated mechanisms, its role in epilepsy remains unclear. AE is not consistently epileptogenic and may be present in other epilepsy syndromes and even in healthy individuals. Most studies focus on adults; little is known about AE in pediatric TLE. We present a pediatric case series examining clinical, imaging, and outcome data to clarify the significance of AE in this population.
Methods:
A retrospective chart review was conducted at Children’s Medical Center Dallas and Plano. Eligible pediatric patients were identified based on predefined inclusion criteria of epilepsy and amygdala enlargement on MRI between January 1, 2000, and May 1, 2025. Collected variables included seizure type, epilepsy etiology, MRI findings, prognosis, treatment details, and psychiatric comorbidities.
Results:
Twenty-seven patients were included in this study. Mean age at seizure onset was 7.7 and a mean age of 10.8 at time of MRI. Six patients had right side AE, 14 had left side AE and 7 had bilateral AE. AE was concordant to epilepsy laterality in 52% of patients. Intractable epilepsy was present in 56% of patients. Developmental delay/intellectual disability was present in 52% of patients and 19% patients had mention of a mood disorder. Autoimmune testing was done in 6 patients, with 1 positive result; two additional patients were treated as presumed autoimmune mediated epilepsy despite negative testing.
Conclusions:
We describe a novel population of pediatric patients with epilepsy and AE. Understanding this patient population can help with evaluation, treatment, including use of autoimmune treatment, and prognostication.
Funding: None