Focal Epilepsy Associated With Acceleration in Progressive Cortical Thinning

Focal epilepsy may accelerate widespread progressive cortical thinning to a greater degree than that observed in normal aging.

Focal epilepsy may accelerate widespread progressive cortical thinning to a greater degree than that observed in normal aging, a study in JAMA Neurology suggests.

The study examined data from a cohort of consecutive patients with focal epilepsy receiving follow-up care at the National Hospital for Neurology and Neurosurgery in London, United Kingdom (n=190). Data were compared with 3 age- and sex-matched independent comparison cohorts consisting of healthy volunteers (n=141). Examined data were derived from ≥2 high-resolution T1-weighted magnetic resonance imaging (MRI) scans taken ≥6 months apart (mean [SD] interval, 2.5 [1.6] years). The primary outcomes of interest were the rate of global and vertexwise progressive cortical thinning.

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Patients with epilepsy had a higher mean overall annual rate of global cortical thinning vs healthy volunteers (0.024 vs 0.011 mm/y, respectively; P =.01). In 146 patients with epilepsy, widespread progressive cortical thinning exceeded that observed in normal aging. Cortical thinning was especially pronounced in bilateral temporal lobes, medial parietal and occipital cortices, pericentral gyri, and opercula (76.8%; 95% CI, 58%-95%).

Adults >55 years of age were found to have an elevated mean rate of annual cortical thinning (aged 18 to <35 years: 0.021 mm/y; P =.07 vs the oldest group aged 35 to <55 years: 0.023 mm/y; P =.04 vs the oldest group aged 55 to <75 years: 0.058 mm/y). Yearly mean rates of cortical thinning were higher among individuals with short (<5 years) epilepsy duration (0.055 mm/y) vs patients with an onset of ≥5 years ago (0.022 mm/y; P =.049).

Limitations of the study were the collection of data from different 3-T MRI scanners as well as the relatively small number of participants in each cohort.

This and future studies, according to the investigators, may ultimately “provide a rationale to include longitudinal imaging in the clinical care of patients with epilepsy and to inform them about these potential risks.”

Disclosure: None of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Galovic M, van Dooren VQH, Postma T, et al. Progressive cortical thinning in patients with focal epilepsy [published online July 1, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.1708.