Abstracts

Various authors have associated structural hippocampal abnormalities and the presence of major depressive disorder (MDD) in patients with or without epilepsy. Besides these, several evidences point to a significantly greater frequency of MDD in temporal lobe epilepsy (TLE) associated with mesial temporal sclerosis (MTS). It is, therefore, believed that there is a link between MTS and MDD. The aim of this study was to evaluate the association between the degree and side of hippocampal atrophy on MRI and the presence of MDD in patients with TLE associated with MTS. 53 patients with refractory TLE who attended at an outpatient clinic had a 1.5T MRI. The images were evaluated by only one observer blinded to the electroclinical data which would allow for the lateralization of the epileptogenic zone. We looked for evidences of hippocampal atrophy (atrophy in T1 and/or hypersignal in FLAIR) as well as the volumetric study through the sequence FFE-T1. The atrophy was considered severe when hippocampal volume was 3 SD below the mean of a control group constituted by individuals without epilepsy (n=13). The psychiatric evaluation consisted of an interview with the patient followed by another with the family. The diagnosis of MDD was done by the SCID-I (DSMIV). The interviewer was also blinded to the electroclinical data. Patients with concomitant personality and chronic psychotic disorders were excluded. Data was analyzed through the correlation test of Spearman. Among the MTS patients (n=53), 56.6% were female, mean age of 34.2 yrs. and 43.4% were male, mean age 38.5 yrs. Severe hippocampal atrophy was seen in 86.8% (n=46). This included severe bilateral atrophy in 15.2% (n=7); unilateral on the right in 28.3% (n=13) and unilateral on the left in 56.5% (n=26). Depression was observed in 17/53 patients with refractory TLE (32%), this being 11/26 patients with severe atrophy of the left hippocampus (LH) (42.3%), 3/13 patients with severe atrophy of right hippocampus (23%) and 4/7 patients with bilateral severe atrophy (57%). None of the patients with slight or moderate hippocampal atrophy presented depression. Despite the greater frequency of depression associated with severe LH atrophy (3 SD below the mean), this association was not statistically significant. However, when the volumes of the LH were analyzed, we found a negative correlation between these and that of depression (r[sub]s[/sub]=-0.308; p=0.025). Considering the adopted parameter of severe atrophy, there was a significant correlation between depression and severe bilateral atrophy (r[sub]s[/sub]= 0.315; p[lt]0.022). Our data point to the association between the presence of depressive psychopathology and refractory epilepsy related to LH atrophy and severe bilateral hippocampal atrophy. (Supported by FAPESP-Funda[ccedil][atilde]o de Amparo [agrave] Pesquisa do Estado de S[atilde]o Paulo.)