TBSS-based Distinguishing of White Matter Microstructural Changes between Temporal Lobe Epilepsy with Normal MRI and Hippocampal Sclerosis

Motivation: Temporal lobe epilepsy (TLE) presents diagnostic challenges, particularly distinguishing between hippocampal sclerosis (HS) and TLE with normal MRI (TLE-NL). Goal(s): This study aims to explore white matter changes in TLE subtypes to better understand their relationship and support clinical decision-making. Approach: Forty-four TLE patients and 30 healthy controls underwent diffusion tensor imaging (DTI). Tract-based spatial statistics (TBSS) were used to analyze white matter microstructural changes. Results: TLE patients showed decreased fractional anisotropy (FA) and increased mean diffusivity (MD) values, with HS patients exhibiting more extensive white matter damage than TLE-NL patients, suggesting they may be distinct diseases. Impact: This study's findings suggest that TLE-HS and TLE-NL are distinct diseases, potentially guiding more personalized treatment strategies and improving patient outcomes. Future research can further investigate the specific mechanisms underlying these differences to enhance diagnostic accuracy.