Decreased Structural Connectivity Between Thalamic Nuclei and Hippocampus in Temporal Lobe Epilepsy—A Diffusion Tensor Imaging‐Based Study

Background Temporal lobe epilepsy (TLE) can lead to structural brain abnormalities, with thalamus atrophy being the most common extratemporal alteration. This study used probabilistic tractography to investigate the structural connectivity between individual thalamic nuclei and the hippocampus in TLE. Methods Thirty‐six TLE patients who underwent pre‐surgical 3 Tesla magnetic resonance imaging (MRI) and 18 healthy controls were enrolled in this study. Patients were subdivided into TLE with HS (TLE‐HS) and MRI‐negative TLE (TLE‐MRneg). Tractography and whole brain segmentation, including thalamus parcellation, were performed to determine the number of streamlines per mm 3 between the thalamic nuclei and hippocampus. Connectivity strength and volume of regions were correlated with clinical data. Results The volume of the entire thalamus ipsilateral to seizure onset was significantly decreased in TLE‐HS compared to controls (Mann–Whitney‐ U test: p FDR < 0.01) with the anterior thalamic nuclei (ANT) as important contributor. Furthermore, decreased ipsilateral connectivity strength between the hippocampus and ANT was detected in TLE‐HS ( p FDR < 0.01) compared to TLE‐MRneg and controls which correlated negatively with the duration of epilepsy ( ρ = −0.512, p = 0.025) and positively with seizure frequency ( ρ = 0.603, p = 0.006). Moreover, ANT volume correlated negatively with epilepsy duration in TLE‐HS ( ρ = −0.471, p = 0.042). Conclusions ANT showed atrophy and decreased connectivity in TLE‐HS, which correlated with epilepsy duration and seizure frequency. Understanding the dynamics of epileptogenic networks has the potential to shed light on surgery‐resistant epilepsy and refine the selection process for ideal neurosurgical candidates, consequently enhancing post‐surgical outcomes.