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A Novel Focal Seizure Pattern Generated in Superficial Layers of the Olfactory Cortex. J Neurosci 2017; 37:3544-3554. [PMID: 28264979 DOI: 10.1523/jneurosci.2239-16.2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 02/03/2023] Open
Abstract
Seizure patterns identified in focal epilepsies caused by diverse etiologies are likely due to different pathogenic mechanisms. We describe here a novel, region-specific focal seizure pattern that mimics seizure activity observed in a subpopulation of patients submitted to presurgical monitoring with intracerebral electrodes. Distinctive seizure-like events (SLEs) are induced in the olfactory regions by acute treatment of both tangential brain slices and the isolated guinea pig brain with the potassium channel blocker 4-aminopyridine. Analysis of field potentials, intracellular activities, and extracellular potassium changes demonstrates that SLEs in the piriform cortex initiate in the superficial layer 1 lacking principal neurons with an activity-dependent increase of extracellular potassium. SLE progression (but not onset) does not require the participation of synaptic transmission and is mediated by diffusion of potassium to deep cortical layers. The novel seizure pattern here described is not observed in other cortical regions; it is proposed to rely on the peculiar organization of the superficial piriform cortex layers, which are characterized by unmyelinated axons and perisynaptic astroglial envelopes. This study reveals a sequence of ictogenic events in the olfactory cortex that were never described before in other cortical structures and supports the notion that altered potassium homeostasis and unmyelinated fibers may represent a potential vehicle for focal ictogenesis.SIGNIFICANCE STATEMENT We describe a novel seizure pattern peculiar of the olfactory cortex that resembles focal seizures with low-voltage fast activity at onset observed in humans. The findings suggest that network mechanisms responsible for seizure onset can be region specific.
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Maynard LM, Leach JL, Horn PS, Spaeth CG, Mangano FT, Holland KD, Miles L, Faist R, Greiner HM. Epilepsy prevalence and severity predictors in MRI-identified focal cortical dysplasia. Epilepsy Res 2017; 132:41-49. [PMID: 28288357 DOI: 10.1016/j.eplepsyres.2017.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/30/2017] [Accepted: 03/02/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the prevalence of epilepsy and drug-resistant epilepsy in pediatric patients with focal cortical dysplasia (FCD) identified by magnetic resonance imaging (MRI). To determine clinical and imaging differences between those with drug-resistant epilepsy, drug-responsive epilepsy, and no epilepsy among children with MRI-identified FCD. METHODS A keyword search of a hospital radiology database identified 97 study participants for inclusion in this retrospective study. Participants were included if they were under 18 years of age at time of database query and had an MRI between 2004 and 2013 showing FCD. Exclusion was based on imaging and clinical characteristics. Data was gathered using a chart review and supplemental questionnaire. RESULTS In this cohort of patients with imaging findings compatible with FCD, 29% had not developed epilepsy. The prevalence of epilepsy and drug-resistant epilepsy was 71.13% (95% C.I.=61.05-79.89%) and 32.99% (95% C.I.=23.78-43.27%), respectively. Patients with epilepsy were more likely to have temporal (p=0.029) or frontal (p=0.044) lobe lesions and a family history of seizures (p=0.003) than those without epilepsy. Age of seizure onset was later in those with drug-responsive epilepsy than those with drug-resistant epilepsy (p=0.0002). A later age of seizure onset (OR=1.22, p=0.0441, 95% C.I.=1.00-1.486) and absence of developmental delay (OR=3.624, p=0.0497, 95% C.I.=1.002-13.110) predicted a less severe epilepsy phenotype. CONCLUSIONS Previous studies have only assessed patient cohorts with FCD and epilepsy, limiting the data on "asymptomatic" or "atypically presenting" FCD. Identifying a surprisingly large, novel cohort of children with FCD that had not developed epilepsy helps define prognosis and inform clinical management of children with FCD on imaging.
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Affiliation(s)
| | - James L Leach
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States
| | - Paul S Horn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States
| | - Christine G Spaeth
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Francesco T Mangano
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States
| | - Katherine D Holland
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States
| | - Lili Miles
- Nemours Children's Hospital, Orlando, FL 32827, United States
| | - Robert Faist
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Hansel M Greiner
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; University of Cincinnati, Cincinnati, OH 45220, United States.
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Scholl T, Mühlebner A, Ricken G, Gruber V, Fabing A, Samueli S, Gröppel G, Dorfer C, Czech T, Hainfellner JA, Prabowo AS, Reinten RJ, Hoogendijk L, Anink JJ, Aronica E, Feucht M. Impaired oligodendroglial turnover is associated with myelin pathology in focal cortical dysplasia and tuberous sclerosis complex. Brain Pathol 2017; 27:770-780. [PMID: 27750396 PMCID: PMC5697648 DOI: 10.1111/bpa.12452] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/06/2016] [Indexed: 12/19/2022] Open
Abstract
Conventional antiepileptic drugs suppress the excessive firing of neurons during seizures. In drug-resistant patients, treatment failure indicates an alternative important epileptogenic trigger. Two epilepsy-associated pathologies show myelin deficiencies in seizure-related brain regions: Focal Cortical Dysplasia IIB (FCD) and cortical tubers in Tuberous Sclerosis Complex (TSC). Studies uncovering white matter-pathology mechanisms are therefore urgently needed to gain more insight into epileptogenesis, the propensity to maintain seizures, and their associated comorbidities such as cognitive defects. We analyzed epilepsy surgery specimens of FCD IIB (n = 22), TSC (n = 8), and other malformations of cortical development MCD (n = 12), and compared them to autopsy and biopsy cases (n = 15). The entire lesional pathology was assessed using digital immunohistochemistry, immunofluorescence and western blotting for oligodendroglial lineage, myelin and mTOR markers, and findings were correlated to clinical parameters. White matter pathology with depleted myelin and oligodendroglia were found in 50% of FCD IIB and 62% of TSC cases. Other MCDs had either a normal content or even showed reactive oligodendrolial hyperplasia. Furthermore, myelin deficiency was associated with increased mTOR expression and the lower amount of oligodendroglia was linked with their precursor cells (PDGFRa). The relative duration of epilepsy (normalized to age) also correlated positively to mTOR activation and negatively to myelination. Decreased content of oligodendroglia and missing precursor cells indicated insufficient oligodendroglial development, probably mediated by mTOR, which may ultimately lead to severe myelin loss. In terms of disease management, an early and targeted treatment could restore normal myelin development and, therefore, alter seizure threshold and improve cognitive outcome.
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Affiliation(s)
- Theresa Scholl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Angelika Mühlebner
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Victoria Gruber
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Fabing
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sharon Samueli
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gudrun Gröppel
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | | | - Avanita S Prabowo
- Department of (Neuro) Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Roy J Reinten
- Department of (Neuro) Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lisette Hoogendijk
- Department of (Neuro) Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jasper J Anink
- Department of (Neuro) Pathology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Academic Medical Centre, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, Centre for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martha Feucht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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Cardinale F, Francione S, Gennari L, Citterio A, Sberna M, Tassi L, Mai R, Sartori I, Nobili L, Cossu M, Castana L, Lo Russo G, Colombo N. SUrface-PRojected FLuid-Attenuation-Inversion-Recovery Analysis: A Novel Tool for Advanced Imaging of Epilepsy. World Neurosurg 2017; 98:715-726.e1. [DOI: 10.1016/j.wneu.2016.11.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 01/17/2023]
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55
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Peixoto-Santos JE, Kandratavicius L, Velasco TR, Assirati JA, Carlotti CG, Scandiuzzi RC, Salmon CEG, Santos ACD, Leite JP. Individual hippocampal subfield assessment indicates that matrix macromolecules and gliosis are key elements for the increased T2 relaxation time seen in temporal lobe epilepsy. Epilepsia 2016; 58:149-159. [PMID: 27864825 DOI: 10.1111/epi.13620] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Increased T2 relaxation time is often seen in temporal lobe epilepsy (TLE) with hippocampal sclerosis. Water content directly affects the effective T2 in a voxel. Our aim was to evaluate the relation between T2 values and two molecules associated with brain water homeostasis aquaporin 4 (AQP4) and chondroitin sulfate proteoglycan (CSPG), as well as cellular populations in the hippocampal region of patients with TLE. METHODS Hippocampal T2 imaging and diffusion tensor imaging (DTI) were obtained from 42 drug-resistant patients with TLE and 20 healthy volunteers (radiologic controls, RCs). A similar protocol (ex vivo) was applied to hippocampal sections from the same TLE cases and 14 autopsy control hippocampi (histologic and radiologic controls, HRCs), and each hippocampal subfield was evaluated. Hippocampal sections from TLE cases and HRC controls were submitted to immunohistochemistry for neurons (neuron nuclei [NeuN]), reactive astrocytes (glial fibrillary acidic protein [GFAP]), activated microglia (human leukocyte antigen-D-related [HLA-DR]), polarized AQP4, and CSPG. RESULTS Patients with TLE had higher in vivo and ex vivo hippocampal T2 relaxation time. Hippocampi from epilepsy cases had lower neuron density, higher gliosis, decreased AQP4 polarization, and increased CSPG immunoreactive area. In vivo relaxation correlated with astrogliosis in the subiculum and extracellular CSPG in the hilus. Ex vivo T2 relaxation time correlated with astrogliosis in the hilus, CA4, and subiculum, and with microgliosis in CA1. The difference between in vivo and ex vivo relaxation ratio correlated with mean diffusivity and with the immunopositive area for CSPG in the hilus. SIGNIFICANCE Our data indicate that astrogliosis, microgliosis, and CSPG expression correlate with the increased T2 relaxation time seen in the hippocampi of patients with TLE.
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Affiliation(s)
- Jose Eduardo Peixoto-Santos
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Ludmyla Kandratavicius
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Tonicarlo Rodrigues Velasco
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Joao Alberto Assirati
- Department of Surgery and Anatomy, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Carlos Gilberto Carlotti
- Department of Surgery and Anatomy, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Renata Caldo Scandiuzzi
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Carlos Ernesto Garrido Salmon
- Department of Physics and Mathematics, Faculty of Philosophy, Science and Languages of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Antonio Carlos Dos Santos
- Department of Internal Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Joao Pereira Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
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Bartolini L, Whitehead MT, Ho C, Sepeta LN, Oluigbo CO, Havens K, Freilich ER, Schreiber JM, Gaillard WD. Temporal lobe epilepsy and focal cortical dysplasia in children: A tip to find the abnormality. Epilepsia 2016; 58:113-122. [DOI: 10.1111/epi.13615] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Luca Bartolini
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Matthew T. Whitehead
- Department of Diagnostic Imaging and Radiology Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Cheng‐Ying Ho
- Department of Pathology Children's National Health System George Washington University Washington District of Columbia U.S.A
- Department of Pathology University of Maryland Baltimore Maryland U.S.A
| | - Leigh N. Sepeta
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Chima O. Oluigbo
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Kathryn Havens
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - Emily R. Freilich
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - John M. Schreiber
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
| | - William D. Gaillard
- Center for Neuroscience Children's National Health System George Washington University Washington District of Columbia U.S.A
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Radhakrishnan R, Leach JL, Mangano FT, Gelfand MJ, Rozhkov L, Miles L, Greiner HM. Prospective detection of cortical dysplasia on clinical MRI in pediatric intractable epilepsy. Pediatr Radiol 2016; 46:1430-8. [PMID: 27112159 DOI: 10.1007/s00247-016-3623-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cortical dysplasia is the most common cause of pediatric refractory epilepsy. MRI detection of epileptogenic lesion is associated with good postsurgical outcome. Additional electrophysiological information is suggested to be helpful in localization of cortical dysplasia. Educational measures were taken to increase the awareness of cortical dysplasia at our institution in the context of a recent International League Against Epilepsy (ILAE 2011) classification of cortical dysplasia. OBJECTIVE To determine changes in the rate of prospective identification of cortical dysplasia on an initial radiology report and also evaluate the benefit of MRI review as part of a multidisciplinary epilepsy conference in identifying previously overlooked MRI findings. MATERIALS AND METHODS We retrospectively evaluated surgically treated children with refractory epilepsy from 2007 to 2014 with cortical dysplasia on histopathology. We analyzed the initial radiology report, preoperative MRI interpretation at multidisciplinary epilepsy conference and subsequent retrospective MRI review with knowledge of the resection site. We recorded additional electrophysiological data and the presence of lobar concordance with the MRI findings. RESULTS Of 78 children (44 MRI lesional) evaluated, 18 had initially overlooked MRI findings. Comparing 2007-2010 to 2011-2014, there was improvement in the rate of overlooked findings on the initial radiology report (54% vs. 13% of lesional cases, respectively; P = 0.008). The majority (72%) were identified at a multidisciplinary conference with lobar concordance of findings with at least one additional electrophysiological investigation in 89%. CONCLUSION Awareness of current classification schemes of cortical dysplasia and image review in the context of a multidisciplinary conference can lead to improved MRI detection of cortical dysplasia in children.
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Affiliation(s)
- Rupa Radhakrishnan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA
| | - Francesco T Mangano
- Department of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA
| | - Leonid Rozhkov
- Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lili Miles
- Department of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hansel M Greiner
- Department of Neurology, Comprehensive Epilepsy Treatment Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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58
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Reeves C, Tachrount M, Thomas D, Michalak Z, Liu J, Ellis M, Diehl B, Miserocchi A, McEvoy AW, Eriksson S, Yousry T, Thom M. Combined Ex Vivo 9.4T MRI and Quantitative Histopathological Study in Normal and Pathological Neocortical Resections in Focal Epilepsy. Brain Pathol 2016; 26:319-33. [PMID: 26268959 PMCID: PMC4950048 DOI: 10.1111/bpa.12298] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/07/2015] [Indexed: 01/04/2023] Open
Abstract
High-resolution magnetic resonance imaging (MRI) may improve the preoperative diagnosis of focal cortical dysplasia (FCD) in epilepsy. Quantitative 9.4T MRI was carried out (T1, T2, T2* and magnetization transfer ratio) on 13 cortical resections, representing pathologically confirmed FCD (five cases) and normal cortex. Quantitative immunohistochemistry for myelination (myelin basic protein/SMI94), neuronal populations [microtubule-associated protein 2 (MAP2), neurofilament (SMI31, SMI32), synaptophysin, NeuN, calbindin], reactive glia (GFAP), microglia (CD68) and blood-brain barrier permeability (albumin) was carried out in 43 regions of interest (ROI) from normal and abnormal white matter and cortex. MRI was spatially aligned and quantitative analysis carried out on corresponding ROI. Line profile analysis (LPA) of intensity gradients through the cortex was carried out on MRI and immunostained sections. An inverse correlation was noted between myelin/SMI94 and T1, T2 (P < 0.005) and T2* (P < 0.05; Spearman's correlation) and a positive correlation between neuronal MAP2 and T1 (P < 0.005) and T2* (P < 0.05) over all ROI. Similar pathology-MRI correlations were observed for histologically unremarkable white matter ROI only. LPA showed altered gradient contours in regions of FCD, reflecting abnormal cortical lamination and myelo-architecture, including a preoperatively undetected FCD case. This study demonstrates the ability of quantitative 9.4T MRI to detect subtle differences in neuronal numbers and myelination in histologically normal appearing white matter and LPA in the evaluation of cortical dyslamination. These methods may be translatable to the in vivo detection of mild cortical malformations.
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Affiliation(s)
- Cheryl Reeves
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Mohamed Tachrount
- Department of NeuroradiologyUCL, Institute of NeurologyLondonUK
- Department of Brain Repair and RehabilitationUCL, Institute of NeurologyLondonUK
| | - David Thomas
- Department of Brain Repair and RehabilitationUCL, Institute of NeurologyLondonUK
| | - Zuzanna Michalak
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Joan Liu
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Matthew Ellis
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
| | - Beate Diehl
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Anna Miserocchi
- Department of NeurosurgeryUCL, Institute of NeurologyLondonUK
| | - Andrew W. McEvoy
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
- Department of NeurosurgeryUCL, Institute of NeurologyLondonUK
| | - Sofia Eriksson
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Tarek Yousry
- Department of NeuroradiologyUCL, Institute of NeurologyLondonUK
- Department of Brain Repair and RehabilitationUCL, Institute of NeurologyLondonUK
| | - Maria Thom
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
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Martinoni M, Berti PP, Marucci G, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Giulioni M. Pathology-Based Approach to Seizure Outcome After Surgery for Pharmacoresistant Medial Temporal Lobe Epilepsy. World Neurosurg 2016; 90:448-453. [PMID: 26968448 DOI: 10.1016/j.wneu.2016.02.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hippocampal sclerosis (HS) is the most common cause of drug-resistant medial temporal lobe epilepsy (MTLE). Structural abnormalities such as HS, granule cell pathology (GCP), and focal cortical dysplasia (FCD) have been classified histopathologically, possibly allowing a more accurate assessment of prognostic seizure and neuropsychologic outcomes. We correlated seizure outcome with comprehensive temporal lobe pathologic findings, identified according to the most recent classification systems of HS, GCP, and FCD. METHODS All the 83 patients who underwent anterior temporal lobectomy (ATL) for drug-resistant MTLE and with a proven diagnosis of HS between April 2001 and May 2014 were collected. Patients were divided in 2 main groups: 1) isolated HS with/without GCP (HS +/- GCP); and 2) HS associated with FCD with/without GCP (HS+FCD +/- GCP). Patients were followed up at least 1 year, and seizure outcome was reported in accordance with Engel classification. RESULTS Group I: HS +/- GCP: Statistical analysis confirmed a better outcome in HS + GCP patients than in HS-no GCP (P < 0.05). Moreover, a better outcome for the patients affected by GCP type I was observed (P < 0.05). Group II: HS+FCD +/- GCP: Patients with HS variant type I presented a better seizure outcome than the patients with HS type II (Engel class IA HS type I vs. type II: 69% vs. 40%). CONCLUSIONS A pathology-based approach to epilepsy surgery might improve the interpretation of the results, could predict which cases will enjoy a better seizure outcome, and could help to the comprehension of the causes of failures.
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Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Pier Paolo Berti
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Gianluca Marucci
- Section of Pathology, "M. Malpighi," Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Dianalund, Denmark
| | - Lilia Volpi
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- IRCCS Institute of Neurological Science of Bologna, Division of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Science of Bologna, Division of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Science of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
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60
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Giulioni M, Martinoni M, Marucci G. Temporal plus epilepsy is a major determinant of temporal lobe surgery failures. Brain 2016; 139:e35. [PMID: 26966137 DOI: 10.1093/brain/aww040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Marco Giulioni
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Matteo Martinoni
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neurosurgery, Bellaria Hospital, Bologna, Italy
| | - Gianluca Marucci
- Section of Pathology "M. Malpighi", Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
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Schurr J, Coras R, Rössler K, Pieper T, Kudernatsch M, Holthausen H, Winkler P, Woermann F, Bien CG, Polster T, Schulz R, Kalbhenn T, Urbach H, Becker A, Grunwald T, Huppertz HJ, Gil-Nagel A, Toledano R, Feucht M, Mühlebner A, Czech T, Blümcke I. Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia in Frontal Lobe Epilepsy: A New Clinico-Pathological Entity. Brain Pathol 2016; 27:26-35. [PMID: 26748554 DOI: 10.1111/bpa.12347] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/21/2015] [Indexed: 01/06/2023] Open
Abstract
The histopathological spectrum of human epileptogenic brain lesions is widespread including common and rare variants of cortical malformations. However, 2-26% of epilepsy surgery specimens are histopathologically classified as nonlesional. We hypothesized that these specimens include also new diagnostic entities, in particular when presurgical magnetic resonance imaging (MRI) can identify abnormal signal intensities within the anatomical region of seizure onset. In our series of 1381 en bloc resected epilepsy surgery brain specimens, 52 cases could not be histopathologically classified and were considered nonlesional (3.7%). An increase of Olig2-, and PDGFR-alpha-immunoreactive oligodendroglia was observed in white matter and deep cortical layers in 22 of these patients (42%). Increased proliferation activity as well as heterotopic neurons in white matter were additional histopathological hallmarks. All patients suffered from frontal lobe epilepsy (FLE) with a median age of epilepsy onset at 4 years and 16 years at epilepsy surgery. Presurgical MRI suggested focal cortical dysplasia (FCD) in all patients. We suggest to classify this characteristic histopathology pattern as "mild malformation of cortical development with oligodendroglial hyperplasia (MOGHE)." Further insights into pathomechanisms of MOGHE may help to bridge the diagnostic gap in children and young adults with difficult-to-treat FLE.
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Affiliation(s)
- Johannes Schurr
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Tom Pieper
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | - Manfred Kudernatsch
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | - Hans Holthausen
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | - Peter Winkler
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Vogtareuth, Germany
| | | | | | - Tilman Polster
- Epilepsy Center Bethel, Hospital Mara, Bielefeld, Germany
| | | | - Thilo Kalbhenn
- Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Kantensiek 11, 33617 Bielefeld, Germany
| | - Horst Urbach
- Department of Radiology, University Hospital Bonn, 53127 Bonn, Germany.,Department of Radiology, University Hospital Freiburg, Freiburg, Germany
| | - Albert Becker
- Department of Neuropathology, University Hospital Bonn, 53127 Bonn, Germany
| | | | | | - Antonio Gil-Nagel
- Servicio de Neurología, Hospital Ruber International, C/La Masó n 38, 28034 Madrid, Spain
| | - Rafael Toledano
- Servicio de Neurología, Hospital Ruber International, C/La Masó n 38, 28034 Madrid, Spain
| | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, 1090 Vienna, Austria
| | - Angelika Mühlebner
- Department of Pediatrics, Medical University Vienna, 1090 Vienna, Austria.,Institute of Neurology, Medical University Vienna, 1090 Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University Vienna, 1090 Vienna, Austria
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Abstract
Imaging is pivotal in the evaluation and management of patients with seizure disorders. Elegant structural neuroimaging with magnetic resonance imaging (MRI) may assist in determining the etiology of focal epilepsy and demonstrating the anatomical changes associated with seizure activity. The high diagnostic yield of MRI to identify the common pathological findings in individuals with focal seizures including mesial temporal sclerosis, vascular anomalies, low-grade glial neoplasms and malformations of cortical development has been demonstrated. Positron emission tomography (PET) is the most commonly performed interictal functional neuroimaging technique that may reveal a focal hypometabolic region concordant with seizure onset. Single photon emission computed tomography (SPECT) studies may assist performance of ictal neuroimaging in patients with pharmacoresistant focal epilepsy being considered for neurosurgical treatment. This chapter highlights neuroimaging developments and innovations, and provides a comprehensive overview of the imaging strategies used to improve the care and management of people with epilepsy.
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Deleo F, Garbelli R, Milesi G, Gozzo F, Bramerio M, Villani F, Cardinale F, Tringali G, Spreafico R, Tassi L. Short- and long-term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology. Epilepsia 2015; 57:306-15. [DOI: 10.1111/epi.13277] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Francesco Deleo
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Rita Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Gloria Milesi
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Francesca Gozzo
- Epilepsy Surgery Centre C. Munari; Niguarda Hospital; Milan Italy
| | | | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | | | - Giovanni Tringali
- Neurosurgery Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit; C. Besta Neurological Institute Foundation; Milan Italy
| | - Laura Tassi
- Epilepsy Surgery Centre C. Munari; Niguarda Hospital; Milan Italy
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64
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Zucca I, Milesi G, Medici V, Tassi L, Didato G, Cardinale F, Tringali G, Colombo N, Bramerio M, D'Incerti L, Freri E, Morbin M, Fugnanesi V, Figini M, Spreafico R, Garbelli R. Type II focal cortical dysplasia: Ex vivo 7T magnetic resonance imaging abnormalities and histopathological comparisons. Ann Neurol 2015; 79:42-58. [PMID: 26448158 DOI: 10.1002/ana.24541] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/18/2015] [Accepted: 10/03/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In the present report, the correlations between ex vivo high-resolution imaging and specific histological and ultrastructural patterns in type II focal cortical dysplasia (FCD) have been studied to explain the differences in the magnetic resonance imaging (MRI) detection of dysplasia and to contribute to the presurgical imaging evaluation of this pathology. METHODS Surgical specimens from 13 patients with FCD IIa/b were submitted to 7T MRI scanning, and then analyzed histologically and ultrastructurally to compare the results with the MRI findings. Region of interest (ROI)-based measures on T2-weighted images (T2wi) were quantitatively evaluated in the lesion and in adjacent perilesional gray and white matter. RESULTS Matched histological sections and 7T T2wi showed that the core of the lesion was characterized by patchy aggregates of abnormal cells and fiber disorganization related to inhomogeneity of intracortical signal intensity. The quantitative approach on T2wi can help to distinguish the lesions and perilesional areas even in a clinical MRI-negative case. The ultrastructural study showed that the strong signal hyperintensity in the white matter of FCD IIb was related to a dysmyelination process associated with severe fiber loss and abnormal cells. Less severe histopathological features were found in FCD IIa, thus reflecting their less evident MRI alterations. INTERPRETATION We suggest that white matter abnormalities in type IIb FCD are due to defects of the myelination processes and maturation, impaired by the presence of balloon cells. To reveal the presence and the border of type II cortical dysplasia on MRI, a quantitative ROI-based analysis (coefficient of variation) is also proposed.
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Affiliation(s)
- Ileana Zucca
- Scientific Department, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Gloria Milesi
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Valentina Medici
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Laura Tassi
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Giuseppe Didato
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Francesco Cardinale
- C. Munari Epilepsy Surgery Center, Niguarda Hospital, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Giovanni Tringali
- Neurosurgery Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Nadia Colombo
- Department of Neuroradiology, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Manuela Bramerio
- Department of Pathology, Niguarda Hospital, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Ludovico D'Incerti
- Neuroradiology Unit, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Michela Morbin
- Neurology V and Neuropathology, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Valeria Fugnanesi
- Neurology V and Neuropathology, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Matteo Figini
- Scientific Department, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
| | - Rita Garbelli
- Clinical Epileptology and Experimental Neurophysiology Unit, C. Besta Neurological Institute Foundation, Milan, Italy
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65
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Coras R, Blümcke I. Clinico-pathological subtypes of hippocampal sclerosis in temporal lobe epilepsy and their differential impact on memory impairment. Neuroscience 2015; 309:153-61. [DOI: 10.1016/j.neuroscience.2015.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/30/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
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66
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The Severity of Gliosis in Hippocampal Sclerosis Correlates with Pre-Operative Seizure Burden and Outcome After Temporal Lobectomy. Mol Neurobiol 2015; 53:5446-56. [PMID: 26452360 DOI: 10.1007/s12035-015-9465-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Astrogliosis and microgliosis in hippocampal sclerosis (HS) are widespread and are postulated to contribute to the pro-excitatory neuropathological environment. This study aimed to establish if seizure burden at the time of surgery or post-surgical outcome were correlated with the extent of gliosis in HS. As a secondary aim, we wanted to determine if the degree of gliosis could be predicted by pre-operative neuroimaging.Children and adults who underwent epilepsy surgery for HS between 2002 and 2011 were recruited (n = 43), and age-matched autopsy controls obtained (n = 15). Temporal lobe specimens were examined by DAB immunohistochemistry for astrocytes (glial fibrillary acidic protein (GFAP)) and microglia (CD68). Cell counting for GFAP and CD68 was performed and quantitative densitometry undertaken for GFAP. Seizure variables and outcome (Engel) were determined through medical record and patient review. Seizure frequency in the 6 months prior to surgery was measured to reflect the acute seizure burden. Duration of seizures, age at onset and age at operation were regarded to reflect chronic seizure burden. Focal, lobar and generalized atrophy on pre-operative MRI were independently correlated with the degree of cortical gliosis in the surgical specimen.In HS, both acute and chronic seizure burden were positively correlated with the degree of gliosis. An increase in reactive astrocyte number in CA3 was the strongest predictor of poor post-operative seizure outcome at 1 and 3 years post-operatively in this cohort. Changes in lower cortical astrocyte and upper cortical microglial number also correlated with post-operative outcome at 1 year. Post-surgical seizure outcome (1, 3 and 5 years) did not otherwise correlate with GFAP immunoreactivity (GFAP-IR) or CD68 immunoreactivity (CD68-IR). Increased microglial activation was detected in patients with pre-operative bilateral convulsive seizures, compared to those without convulsive seizures. Furthermore, focal, lobar and generalized atrophy on pre-operative neuroimaging were independently correlated with the degree of cortical gliosis in the surgical specimen.
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67
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Guerrini R, Duchowny M, Jayakar P, Krsek P, Kahane P, Tassi L, Melani F, Polster T, Andre VM, Cepeda C, Krueger DA, Cross JH, Spreafico R, Cosottini M, Gotman J, Chassoux F, Ryvlin P, Bartolomei F, Bernasconi A, Stefan H, Miller I, Devaux B, Najm I, Giordano F, Vonck K, Barba C, Blumcke I. Diagnostic methods and treatment options for focal cortical dysplasia. Epilepsia 2015; 56:1669-86. [DOI: 10.1111/epi.13200] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
- IRCCS Stella Maris Foundation; Pisa Italy
| | - Michael Duchowny
- Neuroscience Program and the Comprehensive Epilepsy Center; Miami Children's Hospital; Miami Florida U.S.A
| | - Prasanna Jayakar
- Department of Neurology; Miami Children's Hospital; Miami Florida U.S.A
| | - Pavel Krsek
- Department of Pediatric Neurology; 2nd Faculty of Medicine; Motol University Hospital; Charles University; Prague Czech Republic
| | - Philippe Kahane
- INSERM U836; University of Grenoble Alpes, GIN; Grenoble; France
- Epilepsy Unit; Michallon Hospital; Grenoble France
| | - Laura Tassi
- Epilepsy Surgery Center; Niguarda Hospital; Milan Italy
| | - Federico Melani
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Tilman Polster
- Department of Child Neurology; Bethel Epilepsy Center; Bielefeld Germany
| | | | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California U.S.A
| | - Darcy A. Krueger
- Division of Neurology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - J. Helen Cross
- UCL-Institute of Child Health; Great Ormond Street Hospital for Children NHS Foundation Trust; London United Kingdom
- Young Epilepsy; Lingfield United Kingdom
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit; Neurological InstituteC. Besta”; Milan Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery; University of Pisa; Pisa Italy
| | - Jean Gotman
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | | | - Philippe Ryvlin
- Department of Clinical Neurosciences; CHUV; Lausanne Switzerland
- Translational and Integrative Group in Epilepsy Research (TIGER) and Institute for Epilepsies (IDEE); Lyon's Neuroscience Center; INSERM U1028; CNRS 5292; UCBL; Le Vinatier Hospital; Bron; Lyon France
| | - Fabrice Bartolomei
- Faculty of Medicine; INSERM, U1106; Institute of Neurosciences of Systems; Marseille France
- Faculty of Medicine; Aix Marseille University; Marseille France
- Clinical Neurophysiology Unit; Department of Clinical Neurosciences; CHU Timone; Marseille France
- Henri-Gastaut Hospital; Saint-Paul Center; Marseille France
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory; McConnell Brain Imaging Center; Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | - Hermann Stefan
- Epilepsy Center Erlangen (ZEE); University Erlangen-Nürnberg; Erlangen Germany
| | - Ian Miller
- Department of Neurology and Comprehensive Epilepsy Program; Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
| | | | - Imad Najm
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland OH U.S.A
| | - Flavio Giordano
- Pediatric Neurosurgery Unit; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology; Department of Neurology; Ghent University; Ghent Belgium
| | - Carmen Barba
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Ingmar Blumcke
- Department of Neuropathology; University Hospital Erlangen; Erlangen Germany
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Di Gennaro G, D'Aniello A, De Risi M, Grillea G, Quarato PP, Mascia A, Grammaldo LG, Casciato S, Morace R, Esposito V, Picardi A. Temporal pole abnormalities in temporal lobe epilepsy with hippocampal sclerosis: Clinical significance and seizure outcome after surgery. Seizure 2015; 32:84-91. [PMID: 26552570 DOI: 10.1016/j.seizure.2015.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/16/2015] [Accepted: 09/20/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To assess the clinical significance of temporal pole abnormalities (temporopolar blurring, TB, and temporopolar atrophy, TA) in patients with temporal lobe epilepsy (TLE) and hippocampal sclerosis (HS) with a long post-surgical follow-up. METHODS We studied 60 consecutive patients with TLE-HS and 1.5 preoperative MRI scans who underwent surgery and were followed up for at least 5 years (mean follow-up 7.3 years). Based on findings of pre-surgical MRI, patients were classified according to the presence of TB or TA. Groups were compared on demographic, clinical, neuropsychological data, and seizure outcome. RESULTS TB was found in 37 (62%) patients, while TA was found in 35 (58%) patients, always ipsilateral to HS, with a high degree of overlap (83%) between TB and TA (p<0.001). Patients with TB did not differ from those without TB with regard to history of febrile convulsions, GTCSs, age of epilepsy onset, side of surgery, seizure frequency, seizure outcome, and neuropsychological outcome. On the other hand, they were significantly older, had a longer duration of epilepsy, and displayed lower preoperative scores on several neuropsychological tests. Similar findings were observed for TA. Multivariate analysis corroborated the association between temporopolar abnormalities and age at onset, age at surgery (for TB only), and lower preoperative scores on some neuropsychological tests. CONCLUSIONS Temporopolar abnormalities are frequent in patients with TLE-HS. Our data support the hypothesis that TB and TA are caused by seizure-related damages. These abnormalities did not influence seizure outcome, even after a long-term post-surgical follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | - Sara Casciato
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | | | - Vincenzo Esposito
- IRCCS "NEUROMED", Pozzilli, IS, Italy; Department of Neurosurgery, Sapienza University of Rome, Italy
| | - Angelo Picardi
- Mental Health Unit, Centre of Epidemiology, Surveillance and Health Promotion, Italian National Institute of Health, Rome, Italy
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Ahmed B, Brodley CE, Blackmon KE, Kuzniecky R, Barash G, Carlson C, Quinn BT, Doyle W, French J, Devinsky O, Thesen T. Cortical feature analysis and machine learning improves detection of "MRI-negative" focal cortical dysplasia. Epilepsy Behav 2015; 48:21-8. [PMID: 26037845 PMCID: PMC4500682 DOI: 10.1016/j.yebeh.2015.04.055] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/16/2022]
Abstract
Focal cortical dysplasia (FCD) is the most common cause of pediatric epilepsy and the third most common lesion in adults with treatment-resistant epilepsy. Advances in MRI have revolutionized the diagnosis of FCD, resulting in higher success rates for resective epilepsy surgery. However, many patients with histologically confirmed FCD have normal presurgical MRI studies ('MRI-negative'), making presurgical diagnosis difficult. The purpose of this study was to test whether a novel MRI postprocessing method successfully detects histopathologically verified FCD in a sample of patients without visually appreciable lesions. We applied an automated quantitative morphometry approach which computed five surface-based MRI features and combined them in a machine learning model to classify lesional and nonlesional vertices. Accuracy was defined by classifying contiguous vertices as "lesional" when they fell within the surgical resection region. Our multivariate method correctly detected the lesion in 6 of 7 MRI-positive patients, which is comparable with the detection rates that have been reported in univariate vertex-based morphometry studies. More significantly, in patients that were MRI-negative, machine learning correctly identified 14 out of 24 FCD lesions (58%). This was achieved after separating abnormal thickness and thinness into distinct classifiers, as well as separating sulcal and gyral regions. Results demonstrate that MRI-negative images contain sufficient information to aid in the in vivo detection of visually elusive FCD lesions.
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Affiliation(s)
- Bilal Ahmed
- Department of Computer Science, Tufts University, Medford, Massachusetts, USA
| | - Carla E. Brodley
- Department of Computer Science, Tufts University, Medford, Massachusetts, USA
| | - Karen E. Blackmon
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Ruben Kuzniecky
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Gilad Barash
- Department of Computer Science, Tufts University, Medford, Massachusetts, USA
| | - Chad Carlson
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Brian T. Quinn
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Werner Doyle
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Jacqueline French
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA
| | - Thomas Thesen
- Comprehensive Epilepsy Center, Department of Neurology, School of Medicine, New York University, New York, USA; Department of Radiology, School of Medicine, New York University, New York, USA.
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70
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Kubota BY, Coan AC, Yasuda CL, Cendes F. T2 hyperintense signal in patients with temporal lobe epilepsy with MRI signs of hippocampal sclerosis and in patients with temporal lobe epilepsy with normal MRI. Epilepsy Behav 2015; 46:103-8. [PMID: 25936278 DOI: 10.1016/j.yebeh.2015.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Increased MRI T2 signal is commonly present not only in the hippocampus but also in other temporal structures of patients with temporal lobe epilepsy (TLE), and it is associated with histological abnormalities related to the epileptogenic lesion. OBJECTIVE This study aimed to verify the distribution of T2 increased signal in temporal lobe structures and its correlations with clinical characteristics of TLE patients with (TLE-HS) or without (TLE-NL) MRI signs of hippocampal sclerosis. METHODS We selected 203 consecutive patients: 124 with TLE-HS and 79 with TLE-NL. Healthy controls (N=59) were used as a comparison group/comparative group. T2 multiecho images obtained via a 3-T MRI were evaluated with in-house software. T2 signal decays were computed from five original echoes in regions of interest in the hippocampus, amygdala, and white matter of the anterior temporal lobe. Values higher than 2 standard deviations from the mean of controls were considered as abnormal. RESULTS T2 signal increase was observed in the hippocampus in 78% of patients with TLE-HS and in 17% of patients with TLE-NL; in the amygdala in 13% of patients with TLE-HS and in 14% of patients with TLE-NL; and in the temporal lobe white matter in 22% of patients with TLE-HS and in 8% of patients with TLE-NL. Group analysis demonstrated a significant difference in the distribution of the T2 relaxation times of the hippocampus (ANOVA, p<0.0001), amygdala (p=0.003), and temporal lobe white matter (p<0.0001) ipsilateral to the epileptogenic zone for patients with TLE-HS compared with controls but only for the amygdala (p=0.029) and temporal lobe white matter (ANOVA, p=0.025) for patients with TLE-NL compared with controls. The average signal from the hippocampus ipsilateral to the epileptogenic zone was significantly higher in patients with no family history of epilepsy (two-sample T-test, p=0.005). CONCLUSION Increased T2 signal occurs in different temporal structures of patients with TLE-HS and in patients with TLE-NL. The hippocampal hyperintense signal is more pronounced in patients without family history of epilepsy and is influenced by earlier seizure onset. These changes in T2 signal may be associated with structural abnormalities related to the epileptogenic zone or to the nature of the initial precipitating injury in patients with TLE.
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Affiliation(s)
- Bruno Yukio Kubota
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, SP, Brazil.
| | - Ana Carolina Coan
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, SP, Brazil.
| | - Clarissa Lin Yasuda
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, SP, Brazil.
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, SP, Brazil.
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71
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Temporopolar blurring in temporal lobe epilepsy with hippocampal sclerosis and long-term prognosis after epilepsy surgery. Epilepsy Res 2015; 112:76-83. [DOI: 10.1016/j.eplepsyres.2015.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/14/2015] [Accepted: 02/17/2015] [Indexed: 11/20/2022]
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72
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Rodríguez-Cruces R, Concha L. White matter in temporal lobe epilepsy: clinico-pathological correlates of water diffusion abnormalities. Quant Imaging Med Surg 2015; 5:264-78. [PMID: 25853084 DOI: 10.3978/j.issn.2223-4292.2015.02.06] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/14/2015] [Indexed: 02/05/2023]
Abstract
Using magnetic resonance imaging, it is possible to measure the behavior of diffusing water molecules, and the metrics derived can be used as indirect markers of tissue micro-architectural properties. Numerous reports have demonstrated that patients with temporal lobe epilepsy (TLE) have water diffusion abnormalities in several white matter structures located within and beyond the epileptogenic temporal lobe, showing that TLE is not a focal disorder, but rather a brain network disease. Differences in severity and spatial extent between patients with or without mesial temporal sclerosis (MTS), as well as differences related to hemispheric seizure onset, are suggestive of different pathophysiological mechanisms behind different forms of TLE, which in turn result in specific cognitive disabilities. The biological interpretation of diffusion abnormalities is based on a wealth of information from animal models of white matter damage, and is supported by recent reports that directly correlate diffusion metrics with histological characteristics of surgical specimens of TLE patients. Thus, there is now more evidence showing that the increased mean diffusivity (MD) and concomitant reductions of diffusion anisotropy that are frequently observed in several white matter bundles in TLE patients reflect reduced axonal density (increased extra-axonal space) due to smaller-caliber axons, and abnormalities in the myelin sheaths of the remaining axons. Whether these histological and diffusion features are a predisposing factor for epilepsy or secondary to seizures is still uncertain; some reports suggest the latter. This article summarizes recent findings in this field and provides a synopsis of the histological features seen most frequently in post-surgical specimens of TLE patients in an effort to aid the interpretation of white matter diffusion abnormalities.
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Affiliation(s)
- Raúl Rodríguez-Cruces
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Luis Concha
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
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Goubran M, de Ribaupierre S, Hammond RR, Currie C, Burneo JG, Parrent AG, Peters TM, Khan AR. Registration of in-vivo to ex-vivo MRI of surgically resected specimens: A pipeline for histology to in-vivo registration. J Neurosci Methods 2015; 241:53-65. [DOI: 10.1016/j.jneumeth.2014.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/03/2014] [Accepted: 12/06/2014] [Indexed: 11/26/2022]
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74
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Goubran M, Hammond RR, de Ribaupierre S, Burneo JG, Mirsattari S, Steven DA, Parrent AG, Peters TM, Khan AR. Magnetic resonance imaging and histology correlation in the neocortex in temporal lobe epilepsy. Ann Neurol 2014; 77:237-50. [PMID: 25424188 DOI: 10.1002/ana.24318] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the histopathological correlates of quantitative relaxometry and diffusion tensor imaging (DTI) and to determine their efficacy in epileptogenic lesion detection for preoperative evaluation of focal epilepsy. METHODS We correlated quantitative relaxometry and DTI with histological features of neuronal density and morphology in 55 regions of the temporal lobe neocortex, selected from 13 patients who underwent epilepsy surgery. We made use of a validated nonrigid image registration protocol to obtain accurate correspondences between in vivo magnetic resonance imaging and histology images. RESULTS We found T1 to be a predictor of neuronal density in the neocortical gray matter (GM) using linear mixed effects models with random effects for subjects. Fractional anisotropy (FA) was a predictor of neuronal density of large-caliber neurons only (pyramidal cells, layers 3 and 5). Comparing multivariate to univariate mixed effects models with nested variables demonstrated that employing T1 and FA together provided a significantly better fit than T1 or FA alone in predicting density of large-caliber neurons. Correlations with clinical variables revealed significant positive correlations between neuronal density and age (rs = 0.726, pfwe = 0.021). This study is the first to relate in vivo T1 and FA values to the proportion of neurons in GM. INTERPRETATION Our results suggest that quantitative T1 mapping and DTI may have a role in preoperative evaluation of focal epilepsy and can be extended to identify GM pathology in a variety of neurological disorders.
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Affiliation(s)
- Maged Goubran
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, London, Ontario, Canada
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75
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Holthausen H, Pieper T, Winkler P, Bluemcke I, Kudernatsch M. Electro-clinical-pathological correlations in focal cortical dysplasia (FCD) at young ages. Childs Nerv Syst 2014; 30:2015-26. [PMID: 25255773 DOI: 10.1007/s00381-014-2549-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 09/02/2014] [Indexed: 12/31/2022]
Abstract
The prevalence of focal cortical dysplasia (FCD) in pediatric patients with focal epilepsy is not exactly known because authors of publications in which the etiologies of epilepsies are listed, but which are not dealing specifically with epilepsy surgery issues, tend to lump together the many kinds of malformations of cortical development (MCD), of which FCDs, because of their relative frequency, are the most relevant subtypes. Out of 561 patients with MCD (children and adults) operated at centers in Europe who do feed data into the "European Epilepsy Brain Bank," 426 (76 %) had FCD.
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Affiliation(s)
- Hans Holthausen
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen-Klinik Vogtareuth, Krankenhausstr. 20, D - 83569, Vogtareuth, Germany,
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76
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Najm IM, Tassi L, Sarnat HB, Holthausen H, Russo GL. Epilepsies associated with focal cortical dysplasias (FCDs). Acta Neuropathol 2014; 128:5-19. [PMID: 24916270 DOI: 10.1007/s00401-014-1304-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/26/2014] [Accepted: 05/26/2014] [Indexed: 11/24/2022]
Abstract
Focal cortical dysplasias (FCDs) are increasingly recognized as one of the most common causes of pharmaco-resistant epilepsies. FCDs were recently divided into various clinico-pathological subtypes due to distinct imaging, electrophysiological, and outcome characteristics. In this review, we will overview the international consensus classification of FCDs in light of more recently reported clinical, electrical, imaging and functional observations, and will also address areas of ongoing debate. In addition, we will summarize our current knowledge on pathobiology and epileptogenicity of FCDs as well as its underlying molecular and cellular mechanisms. The clinical (electroencephalographic, imaging, and functional) characteristics of major FCD subtypes and their implications on the presurgical evaluation and surgical management will be discussed in light of studies describing these characteristics and postoperative seizure outcomes in patients with medically intractable focal epilepsy due to histopathologically confirmed FCDs.
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Affiliation(s)
- Imad M Najm
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA,
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77
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Cendes F, Sakamoto AC, Spreafico R, Bingaman W, Becker AJ. Epilepsies associated with hippocampal sclerosis. Acta Neuropathol 2014; 128:21-37. [PMID: 24823761 DOI: 10.1007/s00401-014-1292-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 01/22/2023]
Abstract
Hippocampal sclerosis (HS) is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy (MTLE). Hippocampal specimens of pharmacoresistant MTLE patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. However, classification issues of hippocampal lesion patterns have been a matter of intense debate. International consensus classification has only recently provided significant progress for comparisons of neurosurgical and clinic-pathological series between different centers. The respective four-tiered classification system of the International League Against Epilepsy subdivides HS into three types and includes a term of "gliosis only, no-HS". Future studies will be necessary to investigate whether each of these subtypes of HS may be related to different etiological factors or with postoperative memory and seizure outcome. Molecular studies have provided potential deeper insights into the pathogenesis of HS and MTLE on the basis of epilepsy-surgical hippocampal specimens and corresponding animal models. These include channelopathies, activation of NMDA receptors, and other conditions related to Ca(2+) influx into neurons, the imbalance of Ca(2+)-binding proteins, acquired channelopathies that increase neuronal excitability, paraneoplastic and non-paraneoplastic inflammatory events, and epigenetic regulation promoting or facilitating hippocampal epileptogenesis. Genetic predisposition for HS is clearly suggested by the high incidence of family history in patients with HS, and by familial MTLE with HS. So far, it is clear that HS is multifactorial and there is no individual pathogenic factor either necessary or sufficient to generate this intriguing histopathological condition. The obvious variety of pathogenetic combinations underlying HS may explain the multitude of clinical presentations, different responses to clinical and surgical treatment. We believe that the stratification of neuropathological patterns can help to characterize specific clinic-pathological entities and predict the postsurgical seizure control in an improved fashion.
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78
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Coras R, Pauli E, Li J, Schwarz M, Rössler K, Buchfelder M, Hamer H, Stefan H, Blumcke I. Differential influence of hippocampal subfields to memory formation: insights from patients with temporal lobe epilepsy. Brain 2014; 137:1945-57. [DOI: 10.1093/brain/awu100] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Blackmon K, Kuzniecky R, Barr WB, Snuderl M, Doyle W, Devinsky O, Thesen T. Cortical Gray-White Matter Blurring and Cognitive Morbidity in Focal Cortical Dysplasia. Cereb Cortex 2014; 25:2854-62. [PMID: 24770710 DOI: 10.1093/cercor/bhu080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Focal cortical dysplasia (FCD) is a malformation of cortical development that is associated with high rates of cognitive morbidity. However, the degree to which specific irregularities of dysplastic tissue directly impact cognition remains unknown. This study investigates the relationship between blurring of the cortical gray and white matter boundary on magnetic resonance imaging (MRI) and global cognitive abilities in FCD. Gray-white blurring (GWB) is quantified by sampling the non-normalized T1 image intensity contrast above and below the gray and white matter interface along the cortical mantle. Spherical averaging is used to compare resulting GWB for patients with histopathologically verified FCD with matched controls. Whole-brain correlational analyses are used to investigate the relationship between blurring and general cognitive abilities, controlling for epilepsy duration. Results show that cognitive performance is reduced in patients with FCD relative to controls. Patients show increased GWB in bilateral temporal, parietal, and frontal regions. Furthermore, increased GWB in these regions is linearly related to decreased cognition and mediates group differences in cognitive performance. These findings demonstrate that GWB is a marker of reduced cognitive efficiency in FCD that can potentially be used to probe general and domain-specific cognitive functions in other neurological disorders.
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Affiliation(s)
- Karen Blackmon
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York 10016, USA
| | - Ruben Kuzniecky
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York 10016, USA
| | - William B Barr
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York 10016, USA
| | - Matija Snuderl
- Department of Pathology, New York University School of Medicine, New York 10016, USA
| | - Werner Doyle
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York 10016, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York 10016, USA
| | - Thomas Thesen
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York 10016, USA
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Jeyaraj MK, Menon RN, Justus S, Alexander A, Sarma PS, Radhakrishnan K. A critical evaluation of the lateralizing significance of material-specific memory deficits in patients with mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Behav 2013; 28:460-6. [PMID: 23891768 DOI: 10.1016/j.yebeh.2013.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/08/2013] [Accepted: 06/14/2013] [Indexed: 02/07/2023]
Abstract
To critically assess the value of material-specific memory deficits in lateralizing temporal lobe dysfunction preoperatively, we compared the neuropsychological data of 50 consecutive patients with unilateral mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS; right: 31, left: 19) with those of 50 age- and education-matched healthy control subjects. On case-control comparison, both the subcohorts with left and right MTLE-HS performed poorly on intelligence tests, in addition to individual memory tests. However, comparison of the verbal and visual memory functions between subcohorts with right and left MTLE-HS revealed that learning trials and delayed word list recall were the only tests that hypothesized left temporal lobe dysfunction. We conclude that material-specific memory deficits are largely test driven, but there is a lateralizing role for task-specific deficits in left MTLE-HS. Although neuropsychological data help to define baseline neuropsychological impairment, caution should be exercised in interpreting the lateralizing value of material-specific memory deficits prior to surgery.
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Affiliation(s)
- Malcolm K Jeyaraj
- R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Blümcke I, Thom M, Aronica E, Armstrong DD, Bartolomei F, Bernasconi A, Bernasconi N, Bien CG, Cendes F, Coras R, Cross JH, Jacques TS, Kahane P, Mathern GW, Miyata H, Moshé SL, Oz B, Özkara Ç, Perucca E, Sisodiya S, Wiebe S, Spreafico R. International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia 2013; 54:1315-29. [PMID: 23692496 DOI: 10.1111/epi.12220] [Citation(s) in RCA: 670] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 12/23/2022]
Abstract
Hippocampal sclerosis (HS) is the most frequent histopathology encountered in patients with drug-resistant temporal lobe epilepsy (TLE). Over the past decades, various attempts have been made to classify specific patterns of hippocampal neuronal cell loss and correlate subtypes with postsurgical outcome. However, no international consensus about definitions and terminology has been achieved. A task force reviewed previous classification schemes and proposes a system based on semiquantitative hippocampal cell loss patterns that can be applied in any histopathology laboratory. Interobserver and intraobserver agreement studies reached consensus to classify three types in anatomically well-preserved hippocampal specimens: HS International League Against Epilepsy (ILAE) type 1 refers always to severe neuronal cell loss and gliosis predominantly in CA1 and CA4 regions, compared to CA1 predominant neuronal cell loss and gliosis (HS ILAE type 2), or CA4 predominant neuronal cell loss and gliosis (HS ILAE type 3). Surgical hippocampus specimens obtained from patients with TLE may also show normal content of neurons with reactive gliosis only (no-HS). HS ILAE type 1 is more often associated with a history of initial precipitating injuries before age 5 years, with early seizure onset, and favorable postsurgical seizure control. CA1 predominant HS ILAE type 2 and CA4 predominant HS ILAE type 3 have been studied less systematically so far, but some reports point to less favorable outcome, and to differences regarding epilepsy history, including age of seizure onset. The proposed international consensus classification will aid in the characterization of specific clinicopathologic syndromes, and explore variability in imaging and electrophysiology findings, and in postsurgical seizure control.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
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