Background: Investigating alterations in brain volumes among individuals with magnetic resonance-negative temporal lobe epilepsy (MRIn-MTLE) is of particular interest in the context of athletes and fitness enthusiasts. In this study, we aimed to examine these brain volume changes and their potential implications.

Methods: We conducted a retrospective analysis of T1-weighted brain images from MRIn-MTLE patients and healthy controls (HC) who were actively engaged in athletics or fitness activities. Brain regions were segmented and quantified using FreeSurfer software, and we compared the volumes of ipsilateral brain regions between patients and controls. We employed Feature Explorer software, based on Pyradiomics, to construct a classification model using volume parameters and assessed its effectiveness in distinguishing between MRIn-MTLE patients and controls.

Results: Significant differences in brain volumes were observed in various regions of the brain, both on the left and right sides, among both HC and MRIn-MTLE patients. Notably, these differences varied by gender. In males, the estimated total intracranial volume (eTIV) and the volumes of specific regions in the left hemisphere were larger in the HC group than in the MRIn-MTLE group. In females, certain brain regions in the right hemisphere were smaller in MRIn-MTLE patients compared to the HC group. The classification model achieved an area under the curve (AUC) of 0.780 and an accuracy of 0.721.

Conclusions: Our study identified notable reductions in brain volumes among MRIn-MTLE patients who are athletes or fitness enthusiasts. Further investigations are needed to understand the underlying physiological and anatomical factors contributing to these differences. The findings suggest that brain volume measurements can serve as valuable features for constructing classification models to differentiate MRIn-MTLE patients from healthy individuals in the athletic and fitness community.