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Title: Bilateral volume reduction in posterior hippocampus in psychosis of epilepsy.
Austin Authors: Allebone, James;Kanaan, Richard A A ;Maller, Jerome;O'Brien, Terry;Mullen, Saul A ;Cook, Mark;Adams, Sophia J;Vogrin, Simon;Vaughan, David N;Connelly, Alan;Kwan, Patrick;Berkovic, Samuel F ;D'Souza, Wendyl J;Jackson, Graeme D ;Velakoulis, Dennis;Wilson, Sarah J
Affiliation: Department of Psychiatry, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia
St Vincent's Hospital, Melbourne, Victoria, Australia
Graeme Clark Institute, University of Melbourne, Melbourne, Australia
ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
Comprehensive Epilepsy Program, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Melbourne, Australia
Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia
Royal Melbourne Hospital, Melbourne, Victoria, Australia
Issue Date: Jun-2019 2019-02-22
Publication information: Journal of neurology, neurosurgery, and psychiatry 2019; 90(6): 688-694
Abstract: Psychosis of epilepsy (POE) occurs more frequently in temporal lobe epilepsy, raising the question as to whether abnormalities of the hippocampus are aetiologically important. Despite decades of investigation, it is unclear whether hippocampal volume is reduced in POE, perhaps due to small sample sizes and methodological limitations of past research. In this study, we examined the volume of the total hippocampus, and the hippocampal head, body and tail, in a large cohort of patients with POE and patients with epilepsy without psychosis (EC). One hundred adults participated: 50 with POE and 50 EC. Total and subregional hippocampal volumes were manually traced and compared between (1) POE and EC; (2) POE with temporal lobe epilepsy, extratemporal lobe epilepsy and generalised epilepsy; and (3) patients with POE with postictal psychosis (PIP) and interictal psychosis (IP). Compared with EC the POE group had smaller total left hippocampus volume (13.5% decrease, p<0.001), and smaller left hippocampal body (13.3% decrease, p=0.002), and left (41.5% decrease, p<0.001) and right (36.4% decrease, p<0.001) hippocampal tail volumes. Hippocampal head volumes did not differ between groups. Posterior hippocampal volumes are bilaterally reduced in POE. Volume loss was observed on a posteroanterior gradient, with severe decreases in the tail and moderate volume decreases in the body, with no difference in the hippocampal head. Posterior hippocampal atrophy is evident to a similar degree in PIP and IP. Our findings converge with those reported for the paradigmatic psychotic disorder, schizophrenia, and suggest that posterior hippocampal atrophy may serve as a biomarker of the risk for psychosis, including in patients with epilepsy.
DOI: 10.1136/jnnp-2018-319396
ORCID: 0000-0003-0992-1917
PubMed URL: 30796132
Type: Journal Article
Subjects: epilepsy
interictal psychosis
postictal psychosis
Appears in Collections:Journal articles

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