Abstract
The cerebellar atrophy in epileptic patient is well known phenomenon. Some authors (Dam, 1970 et al.) attribute this atrophy to the anoxia during seizures, others (Kokenje, 1965 et al.) to the anti-epileptic drug intoxication.
We have quantitatively measured the size of cerebellum on CT films of epileptic patients and analyzed the cerebellar atrophy in relation to the seizure frequency and to the diphenylhydantoin (DPH) medication.
Methods: CT films of 50 idiopathic epileptic patients taken during Feb. 1972-Dec. 1980 were analyzed. (generalized tonic-clonic seizure 37, psycho-motor 5, abscence 4 and others 4). The average periods from the initial seizure and DPH medication to this CT evaluation were 8.1 and 5.8 years respectively. Films of 20 minor head injury cases of the similar age group were used as control.
Thirty-five, 3mm slice, original horizontal films were reconstructed into 1mm slice, sagittal films and the square measures of cerebellum and cerebrum were calculated by planimeter. The ratio of cerebellum to suboccipital space and that of cerebrum to calvalium were used as parameter for the intensiyy of the atrophiet.
Resutis: In control group, the average ratio of cerebellum to suboccipital space is 80.0±2.2% with the decreasing ratio in older cases. In epileptics the ratio comes down to 71.8±7.6%, showing the definite atrophies in epileptics.
There is high correlation coefficiency (r=0.70) between cerebral and cerebellar atrophies in normals. However, in eptileptics there exists very low interrelationship between the two atrophies (0.05).
The accumulated number of seizures have high correlation with the cerebral atrophy (r=0.61), but have low one (r=0.19) with the cerebellar atrophy in epileptics.
The most strongly related factor to the cerebellar atrophy is blood DPH level of the patients (r=0.50). Cases with DPH level of more than 10ug/ml have cerebellar percentage of 64% on average, besides, cases with level of less than 10ug/ml have 74%.
Conclusion: Though the genesis of the cerebellar atrophy in epileptics would be multioriginal, our analysis revealed DPH level has stronger influence on the cerebellar atrophy than the seizure frequency. It is suggested that we have better to start with other drugs than DPH for the control of epilepsy. Further studies with other drugs will be followed.
