Observing the Asymmetry of Amygdaloid Complex in Patients with Complex Partial Attacks

Lobus limbicus is an anatomical basis for understanding the temporal epilepsy because it includes not only the focus of temporal lobe infection but of the frontal lobe as well. With it we can explain many of the phenomena accompanying epilepsy (hallucinations, the change of the eff ects, and so on). Th e goal of this assignment was to explore the asymmetry of amygdaloidal complex in the patients with complex partial attacks. Th e results show that the smallest number of patients with epilepsy have a symmetric (same size) amygdaloidal complex on the left side and the right. According to the asymmetry direction the diff erence in the number of patients with epilepsy is not statistically signifi cant. Coeffi cient of asymmetry shows that the asymmetry on the left side is more frequent in men, while women have the same distribution on both sides. Th e greatest diff erences were found when considering the age factor. So, in all the three groups of evaluated data the diff erences in average age of patients with epilepsy according to total symm. / asymm. were not statistically signifi cant. But, the diff erences in average age depending on the direction of asymmetry were signifi cant. Patients with longer amygdaloidal complex on the left side are signifi cantly younger, both male and female (related to the axial slice, ant. – post. diameter). Th us, we propose the application of MRI technique in examining the asymmetry of the amygdaloidal complex that we used in this assignment as a template for future examinations in a sense of shedding light on the anatomical functions that underlie neuro-psychiatric dysfunctions.


Introduction
In the limbic system visceral functions are integrated with emotional behavior.Th at is best illustrated by clinical picture of complex partial attack with vegetative, psychiatric (dysfunction of a sensible behavior) and motor symptoms (oral automatism).Bilateral injury of the temporal lobe that has a great eff ect on amygdaloidal complex that causes a series of behavioral changes named Kluver -Bucy syndrome.Th is is evident in patients with temporal lobe trauma or after surgical operation on the temporal lobe due to epilepsy.Lobus limbicus is anatomical basis for understanding the temporal epilepsy because it includes not only the focus of temporal lobe infection but of the frontal lobe as well.With it we can explain many of the phenomena accompanying epilepsy (hallucinations, the change of the effects, and so on).Many bodily functions maintain regular rhythms with cycles of diff erent length.Th e role of «biological clock« that regulates these rhythms is a part of the limbic system function.Th erefore, psychomotor epilepsy is frequently associated with epilepsy focused in temporal region.

Material and Methods
 MRI scans of patient with complex partial attacks were used as a background material for this study.Th e size of amygdaloidal complex was measured in two projections: horizontal (axial) and sagittal.In axial projections we measured anterior -posterior and lateral -medial diameters of amygdaloidal complex.We did not measure the amygdaloidal complex in coronal projections, because other cerebral structures make clear diff raction impossible.MRI scans were obtained using MAGNET IMPACT SIEMENS , TESLA in T relaxation ( TR  - / TE  / fi eld of view  x , the layer thickness SL  mm ) and T relaxation ( TR  / TE  fi eld of view  x  for axial and  x  for coronal,  x  for sagittal scans in  mm layer ).Dual sequences are used -PD and T.In PD TR is , and TE .We used head -neck spiral, as well as head spiral.For the measurement of amygdaloidal complex sizes, and their comparison from the right to the left we used a program that evaluates the distance in MRI from Sarajevo Clinics Center Institute of Radiology.Th is study conforms to all the standards of research ethics as proposed by the Ethics Comity of Sarajevo School of Medicine.
For amygdaloidal complex in two projections (axial and sagittal) we gave: .Th e number of patients with epilepsy according to symmetry/asymmetry on the right and left side.

Discussion
Th e precise location of the incorrect anatomical function that underlies neurological and psychiatric dysfunctions just recently became the subject of intensive research in this fi led.In that sense it is important to apply structural and functional techniques of MRI, for future pinpointing of the problems in working with epilepsy.Th erefore, MRI off ers the most sensitive volumetric measurements of hippocampal formation.Chronister R. C. et al. () use limbic system as a reference that pertains to emotions and interconnecting pathways.Authors differentiate centers of aversions and centers of pleasures (gratifi cations).If we stimulate centers of aversions person will face fear or sadness.On the other hand, stimulation of centers of pleasures will have pleasure as a result.Functional interconnections among aversion and gratifi cation centers, according to the authors, contribute to emotional stability.As a consequence, amygdale stimulation can cause fear, while nucleus accumbens stimulation leads to a feeling of happiness and pleasure.
Hadziselimovic et al. (,,,) confirmed that hippocampus and amygdaloidal complex with their positions depend on the position of temporal lobe; that their positions are followed by brain asymmetry and, when analysis of their positions are made it has to be taken into account.Vogeley K. et al. () in Brain image study show loss of upper temporal gyri (smaller size) and abnormal asymmetry example in SCH, but concerning this, there are no sustainable diagnoses.Belin P. et al. () in paper Lateralization of speech and hearing temporal processing prove that auditoria processing of fast acoustic passes is lateralized in human brain as well as that functional asymmetry in temporal processing is most likely contributed to lingual lateralization to the lower level of cortical empting.In their works Tzourio N. et al. () came to the conclusions that size of left temporal plane is relative anatomic indicator for lingual domination and demonstrate that anatomic asymmetry is a part of functional lingual variation.In morphological studies of temporal lobe and the related central temporal structures in children and adolescents from  to  years of age, which were conducted by Jay N. Giedd et al. (), the total volume of temporal lobe was stable, while amygdale increased its volume only in males and hippocampus increased its volume only in females.This example coexists with the distribution of sex hormonal receptors for this structure; amygdale predominantly hosts androgen receptors while hippocampus predominantly hosts estrogens receptors.
. Analysis of patients with epilepsy according to the approximate size of left and right side.Signifi cance of diff erences was tested with t-test..Distribution of patients with epilepsy according to the diff erence between the right and left side.Th e results are given in tables and diagrams..Th e approximate age of patients with epilepsy according to symmetry / asymmetry on the right and left side.Signifi cance of diff erences was tested with t-test.
Methods of statistical analysis used in this assignment are: .Arithmetic mean .Standard deviation .Standard error .Median .Mod .Chi-square test .t-test diff erences of arithmetic mean . t-test of frequencies .Coeffi cient of asymmetry  BOSNIAN JOURNAL OF BASIC MEDICAL SCIENCES 2007; 7 (1): 21-28 AIDA SARAČ  HADŽIHALILOVIĆ ET AL.: OBSERVING THE ASYMMETRY OF AMYGDALOID COMPLEX IN PATIENTS WITH COMPLEX PARTIAL ATTACKS Coeffi cient of asymmetry indicates asymmetry on the right side, for right side and for both sex, and left asymmetry, for left side and for both sex.Asymmetry is particularly pronounced on the right side in female.