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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Feb;68(2):162–169. doi: 10.1136/jnnp.68.2.162

Reduction of frontal neocortical grey matter associated with affective aggression in patients with temporal lobe epilepsy: an objective voxel by voxel analysis of automatically segmented MRI

F Woermann 1, L T van Elst 1, M Koepp 1, S Free 1, P Thompson 1, M Trimble 1, J Duncan 1
PMCID: PMC1736801  PMID: 10644781

Abstract

BACKGROUND—Interictal episodes of aggression are often reported in patients with epilepsy. Some have characteristics of what has been referred to as episodic dyscontrol or intermittent explosive disorder (IED). Although structural brain abnormalities are thought to play a part in the pathophysiology of aggression, there are few in vivo studies of structural cerebral changes in patients with epilepsy and aggression. Using quantitative MRI, subtle structural brain abnormalities can be investigated in subgroups of patients with both epilepsy and episodes of affective aggression.
METHODS—After automated segmentation of cerebral grey matter from T1 weighted MRI, the objective technique of statistical parametric mapping (SPM) was applied to the analysis of 35 control subjects, 24 patients with temporal lobe epilepsy (TLE) with a history of repeated, interictal episodes of aggression, and 24 patients with TLE without episodes of aggression. Both TLE patient groups were compared with each other and with the control subjects on a voxel by voxel basis for increases and decreases of grey matter.
RESULTS—The patients with TLE with aggressive episodes had a decrease of grey matter, most markedly in the left frontal lobe, compared with the control group and with patients with TLE without aggressive episodes.
CONCLUSION—These findings suggest that a reduction of frontal neocortical grey matter might underly the pathophysiology of aggression in TLE. These voxel by voxel comparisons can guide further in vivo studies into aggression.



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Selected References

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  1. Ashburner J., Friston K. Multimodal image coregistration and partitioning--a unified framework. Neuroimage. 1997 Oct;6(3):209–217. doi: 10.1006/nimg.1997.0290. [DOI] [PubMed] [Google Scholar]
  2. Bach-y-Rita G., Lion J. R., Climent C. E., Ervin F. R. Episodic dyscontrol: a study of 130 violent patients. Am J Psychiatry. 1971 May;127(11):1473–1478. doi: 10.1176/ajp.127.11.1473. [DOI] [PubMed] [Google Scholar]
  3. Barratt E. S., Stanford M. S., Kent T. A., Felthous A. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry. 1997 May 15;41(10):1045–1061. doi: 10.1016/s0006-3223(96)00175-8. [DOI] [PubMed] [Google Scholar]
  4. Baxendale S. A., Sisodiya S. M., Thompson P. J., Free S. L., Kitchen N. D., Stevens J. M., Harkness W. F., Fish D. R., Shorvon S. D. Disproportion in the distribution of gray and white matter: neuropsychological correlates. Neurology. 1999 Jan 15;52(2):248–252. doi: 10.1212/wnl.52.2.248. [DOI] [PubMed] [Google Scholar]
  5. Bear D. M. Hemispheric specialization and the neurology of emotion. Arch Neurol. 1983 Apr;40(4):195–202. doi: 10.1001/archneur.1983.04050040025003. [DOI] [PubMed] [Google Scholar]
  6. Chua S. E., Wright I. C., Poline J. B., Liddle P. F., Murray R. M., Frackowiak R. S., Friston K. J., McGuire P. K. Grey matter correlates of syndromes in schizophrenia. A semi-automated analysis of structural magnetic resonance images. Br J Psychiatry. 1997 May;170:406–410. doi: 10.1192/bjp.170.5.406. [DOI] [PubMed] [Google Scholar]
  7. Crowe S. F. Dissociation of two frontal lobe syndromes by a test of verbal fluency. J Clin Exp Neuropsychol. 1992 Mar;14(2):327–339. doi: 10.1080/01688639208402832. [DOI] [PubMed] [Google Scholar]
  8. Devinsky O., Ronsaville D., Cox C., Witt E., Fedio P., Theodore W. H. Interictal aggression in epilepsy: the Buss-Durkee Hostility Inventory. Epilepsia. 1994 May-Jun;35(3):585–590. doi: 10.1111/j.1528-1157.1994.tb02478.x. [DOI] [PubMed] [Google Scholar]
  9. Duncan J. S. Imaging and epilepsy. Brain. 1997 Feb;120(Pt 2):339–377. doi: 10.1093/brain/120.2.339. [DOI] [PubMed] [Google Scholar]
  10. Elliott F. A. Neurological findings in adult minimal brain dysfunction and the dyscontrol syndrome. J Nerv Ment Dis. 1982 Nov;170(11):680–687. doi: 10.1097/00005053-198211000-00007. [DOI] [PubMed] [Google Scholar]
  11. Elliott F. A. Violence. The neurologic contribution: an overview. Arch Neurol. 1992 Jun;49(6):595–603. doi: 10.1001/archneur.1992.00530300027006. [DOI] [PubMed] [Google Scholar]
  12. Foster H. G., Hillbrand M., Silverstein M. Neuropsychological deficit and aggressive behavior: a prospective study. Prog Neuropsychopharmacol Biol Psychiatry. 1993 Nov;17(6):939–946. doi: 10.1016/0278-5846(93)90021-j. [DOI] [PubMed] [Google Scholar]
  13. Friston K. J., Frith C. D., Liddle P. F., Dolan R. J., Lammertsma A. A., Frackowiak R. S. The relationship between global and local changes in PET scans. J Cereb Blood Flow Metab. 1990 Jul;10(4):458–466. doi: 10.1038/jcbfm.1990.88. [DOI] [PubMed] [Google Scholar]
  14. Krams M., Quinton R., Ashburner J., Friston K. J., Frackowiak R. S., Bouloux P. M., Passingham R. E. Kallmann's syndrome: mirror movements associated with bilateral corticospinal tract hypertrophy. Neurology. 1999 Mar 10;52(4):816–822. doi: 10.1212/wnl.52.4.816. [DOI] [PubMed] [Google Scholar]
  15. Lawrie S. M., Abukmeil S. S. Brain abnormality in schizophrenia. A systematic and quantitative review of volumetric magnetic resonance imaging studies. Br J Psychiatry. 1998 Feb;172:110–120. doi: 10.1192/bjp.172.2.110. [DOI] [PubMed] [Google Scholar]
  16. Levin R., Banks S., Berg B. Psychosocial dimensions of epilepsy: a review of the literature. Epilepsia. 1988 Nov-Dec;29(6):805–816. doi: 10.1111/j.1528-1157.1988.tb04238.x. [DOI] [PubMed] [Google Scholar]
  17. Mak M., De Koning P. Clinical research in aggressive patients, pitfalls in study design and measurement of aggression. Prog Neuropsychopharmacol Biol Psychiatry. 1995 Oct;19(6):993–1017. doi: 10.1016/0278-5846(95)00193-x. [DOI] [PubMed] [Google Scholar]
  18. Meiners L. C., van Gils A., Jansen G. H., de Kort G., Witkamp T. D., Ramos L. M., Valk J., Debets R. M., van Huffelen A. C., van Veelen C. W. Temporal lobe epilepsy: the various MR appearances of histologically proven mesial temporal sclerosis. AJNR Am J Neuroradiol. 1994 Sep;15(8):1547–1555. [PMC free article] [PubMed] [Google Scholar]
  19. Pritchard P. B., 3rd, Lombroso C. T., McIntyre M. Psychological complications of temporal lobe epilepsy. Neurology. 1980 Mar;30(3):227–232. doi: 10.1212/wnl.30.3.227. [DOI] [PubMed] [Google Scholar]
  20. Raine A., Phil D., Stoddard J., Bihrle S., Buchsbaum M. Prefrontal glucose deficits in murderers lacking psychosocial deprivation. Neuropsychiatry Neuropsychol Behav Neurol. 1998 Jan;11(1):1–7. [PubMed] [Google Scholar]
  21. Richardson M. P., Friston K. J., Sisodiya S. M., Koepp M. J., Ashburner J., Free S. L., Brooks D. J., Duncan J. S. Cortical grey matter and benzodiazepine receptors in malformations of cortical development. A voxel-based comparison of structural and functional imaging data. Brain. 1997 Nov;120(Pt 11):1961–1973. doi: 10.1093/brain/120.11.1961. [DOI] [PubMed] [Google Scholar]
  22. Robb R. A., Hanson D. P., Karwoski R. A., Larson A. G., Workman E. L., Stacy M. C. Analyze: a comprehensive, operator-interactive software package for multidimensional medical image display and analysis. Comput Med Imaging Graph. 1989 Nov-Dec;13(6):433–454. doi: 10.1016/0895-6111(89)90285-1. [DOI] [PubMed] [Google Scholar]
  23. Shah P. J., Ebmeier K. P., Glabus M. F., Goodwin G. M. Cortical grey matter reductions associated with treatment-resistant chronic unipolar depression. Controlled magnetic resonance imaging study. Br J Psychiatry. 1998 Jun;172:527–532. doi: 10.1192/bjp.172.6.527. [DOI] [PubMed] [Google Scholar]
  24. Sheline Y. I., Wang P. W., Gado M. H., Csernansky J. G., Vannier M. W. Hippocampal atrophy in recurrent major depression. Proc Natl Acad Sci U S A. 1996 Apr 30;93(9):3908–3913. doi: 10.1073/pnas.93.9.3908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Sisodiya S. M., Moran N., Free S. L., Kitchen N. D., Stevens J. M., Harkness W. F., Fish D. R., Shorvon S. D. Correlation of widespread preoperative magnetic resonance imaging changes with unsuccessful surgery for hippocampal sclerosis. Ann Neurol. 1997 Apr;41(4):490–496. doi: 10.1002/ana.410410412. [DOI] [PubMed] [Google Scholar]
  26. Woermann F. G., Free S. L., Koepp M. J., Ashburner J., Duncan J. S. Voxel-by-voxel comparison of automatically segmented cerebral gray matter--A rater-independent comparison of structural MRI in patients with epilepsy. Neuroimage. 1999 Oct;10(4):373–384. doi: 10.1006/nimg.1999.0481. [DOI] [PubMed] [Google Scholar]
  27. Wright I. C., McGuire P. K., Poline J. B., Travere J. M., Murray R. M., Frith C. D., Frackowiak R. S., Friston K. J. A voxel-based method for the statistical analysis of gray and white matter density applied to schizophrenia. Neuroimage. 1995 Dec;2(4):244–252. doi: 10.1006/nimg.1995.1032. [DOI] [PubMed] [Google Scholar]

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