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Li Y, Liu P, Lin Q, Zhou D, An D. Postoperative seizure and memory outcome of temporal lobe epilepsy with hippocampal sclerosis: A systematic review. Epilepsia 2023; 64:2845-2860. [PMID: 37611927 DOI: 10.1111/epi.17757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
We conducted a systematic review and meta-analysis to evaluate postoperative seizure and memory outcomes of temporal lobe epilepsy with different hippocampal sclerosis (HS) subtypes classified by International League Against Epilepsy (ILAE) Consensus Guidelines in 2013. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines, we searched PubMed, Embase, Web of Science, and Cochrane Library from January 1, 2013 to August 6, 2023. Observational studies reporting seizure and memory outcomes among different HS subtypes were included. We used the Newcastle-Ottawa scale to assess the risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to grade the quality of evidence. Seizure freedom and improved outcome (Engel 1 or ILAE class 1-2) ≥1 year after surgery were defined as the primary and secondary seizure outcome. A random-effects meta-analysis by DerSimonian and Laird method was performed to obtain pooled risk ratio (RRs) with 95% confidence interval (CIs). The memory impairment was narratively reviewed because of various evaluation tools. Fifteen cohort studies with 2485 patients were eligible for the meta-analysis of seizure outcome. Six cohorts with detailed information on postoperative memory outcome were included. The pooled RRs of seizure freedom, with moderate to substantial heterogeneity, were .98 (95% CI = .84-1.15) between HS type 2 and type 1, 1.11 (95% CI = .82-1.52) between type 3 and type 1, and .80 (95% CI = .62-1.03) between the no-HS and HS groups. No significant difference of improved outcome was found between different subtypes (p > .05). The quality of evidence was deemed to be low to very low according to GRADE. The long-term seizure outcome (≥5 years after surgery) and memory impairment remained controversial.
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Affiliation(s)
- Yuming Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Peiwen Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiuxing Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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2
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Whitebirch AC, Santoro B, Barnett A, Lisgaras CP, Scharfman HE, Siegelbaum SA. Reduced Cholecystokinin-Expressing Interneuron Input Contributes to Disinhibition of the Hippocampal CA2 Region in a Mouse Model of Temporal Lobe Epilepsy. J Neurosci 2023; 43:6930-6949. [PMID: 37643861 PMCID: PMC10573827 DOI: 10.1523/jneurosci.2091-22.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
A significant proportion of temporal lobe epilepsy (TLE) patients experience drug-resistant seizures associated with mesial temporal sclerosis, in which there is extensive cell loss in the hippocampal CA1 and CA3 subfields, with a relative sparing of dentate gyrus granule cells and CA2 pyramidal neurons (PNs). A role for CA2 in seizure generation was suggested based on findings of a reduction in CA2 synaptic inhibition (Williamson and Spencer, 1994) and the presence of interictal-like spike activity in CA2 in resected hippocampal tissue from TLE patients (Wittner et al., 2009). We recently found that in the pilocarpine-induced status epilepticus (PILO-SE) mouse model of TLE there was an increase in CA2 intrinsic excitability associated with a loss of CA2 synaptic inhibition. Furthermore, chemogenetic silencing of CA2 significantly reduced seizure frequency, consistent with a role of CA2 in promoting seizure generation and/or propagation (Whitebirch et al., 2022). In the present study, we explored the cellular basis of this inhibitory deficit using immunohistochemical and electrophysiological approaches in PILO-SE male and female mice. We report a widespread decrease in the density of pro-cholecystokinin-immunopositive (CCK+) interneurons and a functional impairment of CCK+ interneuron-mediated inhibition of CA2 PNs. We also found a disruption in the perisomatic perineuronal net in the CA2 stratum pyramidale. Such pathologic alterations may contribute to an enhanced excitation of CA2 PNs and CA2-dependent seizure activity in the PILO-SE mouse model.SIGNIFICANCE STATEMENT Impaired synaptic inhibition in hippocampal circuits has been identified as a key feature that contributes to the emergence and propagation of seizure activity in human patients and animal models of temporal lobe epilepsy (TLE). Among the hippocampal subfields, the CA2 region is particularly resilient to seizure-associated neurodegeneration and has been suggested to play a key role in seizure activity in TLE. Here we report that perisomatic inhibition of CA2 pyramidal neurons mediated by cholecystokinin-expressing interneurons is selectively reduced in acute hippocampal slices from epileptic mice. Parvalbumin-expressing interneurons, in contrast, appear relatively conserved in epileptic mice. These findings advance our understanding of the cellular mechanisms underlying inhibitory disruption in hippocampal circuits in a mouse model of spontaneous recurring seizures.
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Affiliation(s)
- Alexander C Whitebirch
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
| | - Bina Santoro
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
| | - Anastasia Barnett
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
| | - Christos Panagiotis Lisgaras
- Department of Child & Adolescent Psychiatry, New York University Langone Health, New York, New York 10016
- Department of Neuroscience & Physiology, New York University Langone Health, New York, New York 10016
- Department of Psychiatry, New York University Langone Health, New York, New York 10016
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Helen E Scharfman
- Department of Child & Adolescent Psychiatry, New York University Langone Health, New York, New York 10016
- Department of Neuroscience & Physiology, New York University Langone Health, New York, New York 10016
- Department of Psychiatry, New York University Langone Health, New York, New York 10016
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Steven A Siegelbaum
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
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3
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Li W, Jiang Y, Li X, Huang H, Lei D, Li J, Zhang H, Yao D, Luo C, Gong Q, Zhou D, An D. More extensive structural damage in temporal lobe epilepsy with hippocampal sclerosis type 1. Seizure 2023; 111:130-137. [PMID: 37633152 DOI: 10.1016/j.seizure.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVE To explore clinical and structural differences between mesial temporal lobe epilepsy (mTLE) patients with different hippocampal sclerosis (HS) subtypes. METHODS High-resolution T1-weighted MRI and diffusion tensor imaging data were obtained in 41 refractory mTLE patients and 52 age- and sex-matched healthy controls. Postoperative histopathological examination confirmed HS type 1 in 30 patients and HS type 2 in eleven patients. Clinical features, postoperative seizure outcomes, hippocampal subfields volumes, fractional anisotropy (FA) values of white matter regions and graph theory parameters were explored and compared between the HS type 1 and HS type 2 groups. RESULTS No significant differences in clinical features and postsurgical seizure outcomes were found between the HS type 1 and type 2 groups. However, the HS type 1 group showed extra atrophy in ipsilateral parasubiculum than healthy controls and more severe atrophy in contralateral hippocampal fissure than the HS type 2 group. More extensive FA decrease were also observed in the HS type 1 group, involving ipsilateral optic radiation, superior fronto-occipital fasciculus, contralateral uncinate fasciculus, tapetum, bilateral hippocampal cingulum, corona radiata, etc. Furthermore, in spite of similar impairments in characteristic path length, global efficiency and local efficiency in two HS groups, the HS type 1 group showed additional decrease of clustering coefficient than healthy controls. CONCLUSIONS HS type 1 and 2 groups had similar clinical characteristics and postoperative seizure outcomes. More widespread neuronal cell loss in the HS type 1 group contributed to more extensive structural damage and connectivity abnormality. These results shed new light on the imaging correlates of different HS pathology.
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Affiliation(s)
- Wei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China; National Clinical Research Center for Geriatrics, Department of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiuli Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huan Huang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Du Lei
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Heng Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of life Science and technology, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Timechko EE, Yakimov AM, Paramonova AI, Usoltseva AA, Utyashev NP, Ivin NO, Utyasheva AA, Yakunina AV, Kalinin VA, Dmitrenko DV. Mass Spectrometry as a Quantitative Proteomic Analysis Tool for the Search for Temporal Lobe Epilepsy Biomarkers: A Systematic Review. Int J Mol Sci 2023; 24:11130. [PMID: 37446307 DOI: 10.3390/ijms241311130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of epilepsy in adults. Tissue reorganization at the site of the epileptogenic focus is accompanied by changes in the expression patterns of protein molecules. The study of mRNA and its corresponding proteins is crucial for understanding the pathogenesis of the disease. Protein expression profiles do not always directly correlate with the levels of their transcripts; therefore, it is protein profiling that is no less important for understanding the molecular mechanisms and biological processes of TLE. The study and annotation of proteins that are statistically significantly different in patients with TLE is an approach to search for biomarkers of this disease, various stages of its development, as well as a method for searching for specific targets for the development of a further therapeutic strategy. When writing a systematic review, the following aggregators of scientific journals were used: MDPI, PubMed, ScienceDirect, Springer, and Web of Science. Scientific articles were searched using the following keywords: "proteomic", "mass-spectrometry", "protein expression", "temporal lobe epilepsy", and "biomarkers". Publications from 2003 to the present have been analyzed. Studies of brain tissues, experimental models of epilepsy, as well as biological fluids, were analyzed. For each of the groups, aberrantly expressed proteins found in various studies were isolated. Most of the studies omitted important characteristics of the studied patients, such as: duration of illness, type and response to therapy, gender, etc. Proteins that overlap across different tissue types and different studies have been highlighted: DPYSL, SYT1, STMN1, APOE, NME1, and others. The most common biological processes for them were the positive regulation of neurofibrillary tangle assembly, the regulation of amyloid fibril formation, lipoprotein catabolic process, the positive regulation of vesicle fusion, the positive regulation of oxidative stress-induced intrinsic apoptotic signaling pathway, removal of superoxide radicals, axon extension, and the regulation of actin filament depolymerization. MS-based proteomic profiling for a relevant study must accept a number of limitations, the most important of which is the need to compare different types of neurological and, in particular, epileptic disorders. Such a criterion could increase the specificity of the search work and, in the future, lead to the discovery of biomarkers for a particular disease.
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Affiliation(s)
- Elena E Timechko
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Alexey M Yakimov
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Anastasia I Paramonova
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Anna A Usoltseva
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
| | - Nikita P Utyashev
- Federal State Budgetary Institution "National Medical and Surgical Center Named after N.I. Pirogov", 105203 Moscow, Russia
| | - Nikita O Ivin
- Federal State Budgetary Institution "National Medical and Surgical Center Named after N.I. Pirogov", 105203 Moscow, Russia
| | - Anna A Utyasheva
- Federal State Budgetary Institution "National Medical and Surgical Center Named after N.I. Pirogov", 105203 Moscow, Russia
| | - Albina V Yakunina
- Department of Neurology and Neurobiology of Postgraduate Education, Samara State Medical University, 443079 Samara, Russia
| | - Vladimir A Kalinin
- Department of Neurology and Neurobiology of Postgraduate Education, Samara State Medical University, 443079 Samara, Russia
| | - Diana V Dmitrenko
- Department of Medical Genetics and Clinical Neurophysiology of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia
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Adel SAA, Treit S, Abd Wahab W, Little G, Schmitt L, Wilman AH, Beaulieu C, Gross DW. Longitudinal hippocampal diffusion-weighted imaging and T2 relaxometry demonstrate regional abnormalities which are stable and predict subfield pathology in temporal lobe epilepsy. Epilepsia Open 2023; 8:100-112. [PMID: 36461649 PMCID: PMC9977756 DOI: 10.1002/epi4.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/15/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE High-resolution (1 mm isotropic) diffusion tensor imaging (DTI) of the hippocampus in temporal lobe epilepsy (TLE) patients has shown patterns of hippocampal subfield diffusion abnormalities, which were consistent with hippocampal sclerosis (HS) subtype on surgical histology. The objectives of this longitudinal imaging study were to determine the stability of focal hippocampus diffusion changes over time in TLE patients, compare diffusion and quantitative T2 abnormalities of the sclerotic hippocampus, and correlate presurgical mean diffusivity (MD) and T2 maps with postsurgical histology. METHODS Nineteen TLE patients and 19 controls underwent two high-resolution (1 mm isotropic) DTI and 1.1 × 1.1 × 1 mm3 T2 relaxometry scans (in a subset of 16 TLE patients and 9 controls) of the hippocampus at 3T, with a 2.6 ± 0.8 year inter-scan interval. Within-participant hippocampal volume, MD and T2 were compared between the scans. Contralateral hippocampal changes 2.3 ± 1.0 years after surgery and ipsilateral preoperative MD maps versus postoperative subfield histopathology were evaluated in eight patients who underwent surgical resection of the hippocampus. RESULTS Reduced volume and elevated MD and T2 of sclerotic hippocampi remained unchanged between longitudinal scans. Focal regions of elevated MD and T2 in bilateral hippocampi of HS TLE were detected consistently at both scans. Regions of high MD and T2 correlated and remained consistent over time. Volume, MD, and T2 remained unchanged in postoperative contralateral hippocampus. Regional elevations of MD identified subfield neuron loss on postsurgical histology with 88% sensitivity and 88% specificity. Focal T2 elevations identified subfield neuron loss with 75% sensitivity and 88% specificity. SIGNIFICANCE Diffusion and T2 abnormalities in ipsilateral and contralateral hippocampi remained unchanged between the scans suggesting permanent microstructural alterations. MD and T2 demonstrated good sensitivity and specificity to detect hippocampal subfield neuron loss on postsurgical histology, supporting the potential that high-resolution hippocampal DTI and T2 could be used to diagnose HS subtype before surgery.
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Affiliation(s)
- Seyed Amir Ali Adel
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Treit
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Wasan Abd Wahab
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Graham Little
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada.,Department of Computer Science, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Laura Schmitt
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Alan H Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Donald W Gross
- Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
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6
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Whitebirch AC, LaFrancois JJ, Jain S, Leary P, Santoro B, Siegelbaum SA, Scharfman HE. Enhanced excitability of the hippocampal CA2 region and its contribution to seizure activity in a mouse model of temporal lobe epilepsy. Neuron 2022; 110:3121-3138.e8. [PMID: 35987207 PMCID: PMC9547935 DOI: 10.1016/j.neuron.2022.07.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
The hippocampal CA2 region, an area important for social memory, has been suspected to play a role in temporal lobe epilepsy (TLE) because of its resistance to degeneration observed in neighboring CA1 and CA3 regions in both humans and rodent models of TLE. However, little is known about whether alterations in CA2 properties promote seizure generation or propagation. Here, we addressed the role of CA2 using the pilocarpine-induced status epilepticus model of TLE. Ex vivo electrophysiological recordings from acute hippocampal slices revealed a set of coordinated changes that enhance CA2 PC intrinsic excitability, reduce CA2 inhibitory input, and increase CA2 excitatory output to its major CA1 synaptic target. Moreover, selective chemogenetic silencing of CA2 pyramidal cells caused a significant decrease in the frequency of spontaneous seizures measured in vivo. These findings provide the first evidence that CA2 actively contributes to TLE seizure activity and may thus be a promising therapeutic target.
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Affiliation(s)
- Alexander C Whitebirch
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, NY 10027, USA
| | - John J LaFrancois
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Swati Jain
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA
| | - Paige Leary
- Department of Neuroscience and Physiology, New York University Langone Health, New York, NY 10016, USA
| | - Bina Santoro
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, NY 10027, USA
| | - Steven A Siegelbaum
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, NY 10027, USA.
| | - Helen E Scharfman
- Department of Child Psychiatry, New York University Langone Health, New York, NY 10016, USA; Department of Neuroscience and Physiology, New York University Langone Health, New York, NY 10016, USA; Department of Psychiatry, New York University Langone Health, New York, NY 10016, USA; The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA.
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7
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Keller SS. Fingerprinting seizure outcome after temporal lobe surgery using preoperative connectomic mapping. Brain Commun 2022; 4:fcac158. [PMID: 35774186 PMCID: PMC9237732 DOI: 10.1093/braincomms/fcac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022] Open
Abstract
This scientific commentary refers to 'Presurgical temporal lobe epilepsy connectome fingerprint for seizure outcome prediction' by Morgan et al. (https://doi.org/10.1093/braincomms/fcac128) in Brain Communications.
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Affiliation(s)
- Simon S Keller
- Department of Pharmacology and Therapeutics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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8
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Giachetti I, Padelli F, Aquino D, Garbelli R, De Santis D, Rossini L, Deleo F, Pascuzzo R, Coras R, Marucci G, Tringali G, Maccagnano C, De Curtis M, Bruzzone MG, Didato G. Role of NODDI in the MRI Characterization of Hippocampal Abnormalities in Temporal Lobe Epilepsy: Clinico-histopathologic Correlations. Neurology 2022; 98:e1771-e1782. [PMID: 35256485 PMCID: PMC9071371 DOI: 10.1212/wnl.0000000000200140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The identification of possible hippocampal alterations is a crucial point for the diagnosis and therapy of patients with unilateral temporal lobe epilepsy (TLE). OBJECTIVE To investigate the role of Neurite Orientation Dispersion and Density Imaging (NODDI), compared to Diffusion Tensor Imaging (DTI), in the comprehension of hippocampal microstructure in TLE. METHODS DTI and NODDI metrics were calculated in the hippocampi of adult patients with TLE, with and without histology-confirmed hippocampal sclerosis (HS), and in age/sex-matched healthy controls (HC). Diffusion metrics and hippocampal volumes of pathologic side were compared within subjects and between subjects among HS, non-HS, and HC groups. Diffusion metrics were also correlated with hippocampal volume and patients' clinical features. After surgery, hippocampal specimens were processed for neuropathology examinations. RESULTS Fifteen patients with TLE (9 with and 6 without HS) and 11 HC were included. Hippocampal analyses resulted in significant increase in FA (fractional anisotropy) and MD (mean diffusivity, mm2/s × 10-3), decrease in ODI (orientation dispersion index) comparing the pathologic side of patients with HS vs: (1) their relative non-pathological side (0.203 vs 0.183, 0.825 vs 0.724, 0.366 vs 0.443, respectively); (2) the pathologic side of patients without HS (0.203 vs 0.169, 0.825 vs 0.745, 0.366 vs 0.453, respectively); (3) HC (0.203 vs 0.172, 0.825 vs 0.729, 0.366 vs 0.447, respectively). Moreover, ND (neurite density) was significantly decreased comparing both hippocampi of patients with HS (0.416 vs 0.460). A significant increase in fiso (free-water isotropic volume fraction) was found in the comparison of pathologic hippocampi of patients with HS vs: (1) non-pathological hippocampi of patients with HS (0.323 vs 0.258); (2) HC (0.323 vs 0.226). Hippocampal volume of all patients with TLE negatively correlated with MD (r = -0.746, p = 0.0145) and positively correlated with ODI (r = 0.719, p = 0.0145). Fiso and ND of sclerotic hippocampi positively correlated with disease duration (r = 0.684, p = 0.0424 and r = 0.670, p = 0.0486, respectively). Immunohistochemistry in sclerotic hippocampal specimens revealed neuronal loss in pyramidal layer and fiber reorganization at the level of stratum lacunosum-moleculare confirming ODI and ND metrics. DISCUSSION This study shows the capability of diffusion-MRI metrics to detect hippocampal microstructural alterations. Among them, ODI seems to better highlight the fiber reorganization observed by neuropathology in sclerotic hippocampi.
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Affiliation(s)
- Isabella Giachetti
- From the Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Padelli
- From the Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.,Scientific Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico Aquino
- From the Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Dalia De Santis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Laura Rossini
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Francesco Deleo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Riccardo Pascuzzo
- From the Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Tringali
- Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Carmelo Maccagnano
- From the Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marco De Curtis
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Maria Grazia Bruzzone
- From the Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giuseppe Didato
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Abstract
Neuropathological examination of the temporal lobe provides a better understanding and management of a wide spectrum of diseases. We focused on inflammatory diseases, epilepsy, and neurodegenerative diseases, and highlighted how the temporal lobe is particularly involved in those conditions. Although all these diseases are not specific or restricted to the temporal lobe, the temporal lobe is a key structure to understand their pathophysiology. The main histological lesions, immunohistochemical markers, and molecular alterations relevant for the neuropathological diagnostic reasoning are presented in relation to epidemiology, clinical presentation, and radiological findings. The inflammatory diseases section addressed infectious encephalitides and auto-immune encephalitides. The epilepsy section addressed (i) susceptibility of the temporal lobe to epileptogenesis, (ii) epilepsy-associated hippocampal sclerosis, (iii) malformations of cortical development, (iv) changes secondary to epilepsy, (v) long-term epilepsy-associated tumors, (vi) vascular malformations, and (vii) the absence of histological lesion in some epilepsy surgery samples. The neurodegenerative diseases section addressed (i) Alzheimer's disease, (ii) the spectrum of frontotemporal lobar degeneration, (iii) limbic-predominant age-related TDP-43 encephalopathy, and (iv) α-synucleinopathies. Finally, inflammatory diseases, epilepsy, and neurodegenerative diseases are considered as interdependent as some pathophysiological processes cross the boundaries of this classification.
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Affiliation(s)
- Susana Boluda
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, Paris, France; Neuropathology Department, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Danielle Seilhean
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, Paris, France; Neuropathology Department, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France
| | - Franck Bielle
- Sorbonne Université, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, Paris, France; Neuropathology Department, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, AP-HP, Paris, France.
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10
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Twible C, Abdo R, Zhang Q. Astrocyte Role in Temporal Lobe Epilepsy and Development of Mossy Fiber Sprouting. Front Cell Neurosci 2021; 15:725693. [PMID: 34658792 PMCID: PMC8514632 DOI: 10.3389/fncel.2021.725693] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Epilepsy affects approximately 50 million people worldwide, with 60% of adult epilepsies presenting an onset of focal origin. The most common focal epilepsy is temporal lobe epilepsy (TLE). The role of astrocytes in the presentation and development of TLE has been increasingly studied and discussed within the literature. The most common histopathological diagnosis of TLE is hippocampal sclerosis. Hippocampal sclerosis is characterized by neuronal cell loss within the Cornu ammonis and reactive astrogliosis. In some cases, mossy fiber sprouting may be observed. Mossy fiber sprouting has been controversial in its contribution to epileptogenesis in TLE patients, and the mechanisms surrounding the phenomenon have yet to be elucidated. Several studies have reported that mossy fiber sprouting has an almost certain co-existence with reactive astrogliosis within the hippocampus under epileptic conditions. Astrocytes are known to play an important role in the survival and axonal outgrowth of central and peripheral nervous system neurons, pointing to a potential role of astrocytes in TLE and associated cellular alterations. Herein, we review the recent developments surrounding the role of astrocytes in the pathogenic process of TLE and mossy fiber sprouting, with a focus on proposed signaling pathways and cellular mechanisms, histological observations, and clinical correlations in human patients.
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Affiliation(s)
- Carolyn Twible
- Department of Pathology and Lab Medicine, Western University, London, ON, Canada
| | - Rober Abdo
- Department of Pathology and Lab Medicine, Western University, London, ON, Canada.,Department of Anatomy and Cell Biology, Western University, London, ON, Canada
| | - Qi Zhang
- Department of Pathology and Lab Medicine, Western University, London, ON, Canada.,Department of Pathology and Lab Medicine, London Health Sciences Centre, University Hospital, London, ON, Canada
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11
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Hussain U, Baron CA, Khan AR. Tractography in Curvilinear Coordinates. Front Neurosci 2021; 15:716538. [PMID: 34512250 PMCID: PMC8428760 DOI: 10.3389/fnins.2021.716538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Coordinate invariance of physical laws is central in physics, it grants us the freedom to express observations in coordinate systems that provide computational convenience. In the context of medical imaging there are numerous examples where departing from Cartesian to curvilinear coordinates leads to ease of visualization and simplicity, such as spherical coordinates in the brain's cortex, or universal ventricular coordinates in the heart. In this work we introduce tools that enhance the use of existing diffusion tractography approaches to utilize arbitrary coordinates. To test our method we perform simulations that gauge tractography performance by calculating the specificity and sensitivity of tracts generated from curvilinear coordinates in comparison with those generated from Cartesian coordinates, and we find that curvilinear coordinates generally show improved sensitivity and specificity compared to Cartesian. Also, as an application of our method, we show how harmonic coordinates can be used to enhance tractography for the hippocampus.
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Affiliation(s)
- Uzair Hussain
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, ON, Canada
| | - Corey A Baron
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, ON, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Biomedical Engineering, Western University, London, ON, Canada
| | - Ali R Khan
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, Western University, London, ON, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,School of Biomedical Engineering, Western University, London, ON, Canada
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12
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Borger V, Hamed M, Taube J, Aydin G, Ilic I, Schneider M, Schuss P, Güresir E, Becker A, Helmstaedter C, Elger CE, Vatter H. Resective temporal lobe surgery in refractory temporal lobe epilepsy: prognostic factors of postoperative seizure outcome. J Neurosurg 2021. [DOI: 10.3171/2020.7.jns20284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Temporal lobe epilepsy (TLE) is one of the most common forms of epilepsy. In approximately 30% of patients, seizures are refractory to drug treatment. Despite the achievements of modern presurgical evaluation in recent years, the presurgical prediction of seizure outcome remains difficult. The aim of this study was to evaluate the seizure outcome in patients with drug-refractory TLE who underwent resective temporal lobe surgery (rTLS) and to determine features associated with unfavorable postsurgical seizure outcome.
METHODS
Patients with medically refractory TLE who underwent rTLS between 2012 and 2017 were reviewed from the prospectively collected epilepsy surgery database. A retrospective analysis of clinical, radiological, neuropsychological, histopathological, and perioperative findings of 161 patients was performed. The patients were divided into two groups according to seizure outcome (group I, International League Against Epilepsy [ILAE] class 1; group II, ILAE class ≥ 2). For identification of independent risk factors for unfavorable postoperative seizure outcome (ILAE class ≥ 2), a multivariate logistic regression analysis was performed.
RESULTS
Seizure freedom (ILAE class 1) was achieved in 121 patients (75.2%). The neuropsychological evaluation demonstrated that losses in cognitive performance were more pronounced in verbal memory after resections in the left temporal lobe and in nonverbal memory after right-sided resections, whereas attention improved after surgery. Overall, postoperative visual field deficits (VFDs) were common and occurred in 51% of patients. There was no statistically significant difference in the incidence of VFD in patients with selective surgical procedures compared to the patients with nonselective procedures. The lack of MRI lesions and placement of depth electrodes were preoperatively identified as predictors for unfavorable seizure outcome.
CONCLUSIONS
rTLS is an effective treatment method in patients with refractory TLE. However, patients with a lack of MRI lesions and placement of depth electrodes prior to rTLS are at higher risk for an unfavorable postsurgical seizure outcome.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Albert Becker
- Institute of Neuropathology, University Hospital Bonn, Germany
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13
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Neuropathological spectrum of drug resistant epilepsy: 15-years-experience from a tertiary care centre. J Clin Neurosci 2021; 91:226-236. [PMID: 34373032 DOI: 10.1016/j.jocn.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
Neuropathology of drug resistant epilepsy (DRE) has direct bearing on the clinical outcome. Classification of the most common pathologies, hippocampal sclerosis (HS) and focal cortical dysplasia (FCD) have undergone several revisions and studies on the surgical pathology of DRE employing the updated ILAE classification are scarce. Here, we report the neuropathological spectrum of 482 surgically treated cases of DRE from a single institute using the latest ILAE classifications along with clinicoradiologic correlation. Majority of the cases (324, 67.2%) had temporal lobe epilepsy (TLE), with 158 (32.8%) having extratemporal seizure focus. Among TLE, HS was most common (n = 208, 64.2%), followed by neoplasms (42, 13%), FCD (26, 8%) and dual pathology (23, 7%). Less frequent were vascular malformations (cavernoma-3, arteriovenous malformation-1), mild malformation of cortical development (mMCD, 3), gliotic lesions (5), cysticercosis (2), double pathology (2) and polymicrogyria (1). Among extratemporal epilepsies, FCD was most common (46, 29.1%), followed by neoplasms (29, 18.3%), gliotic lesions (27, 17.1%), Rasmussen encephalitis (18, 11.4%), hypothalamic hamartoma (12, 7.6%), malformations of cortical development (10, 6.3%) and vascular malformations (6, 3.8%). Less frequent were double pathology (2, cysticercosis + FCD type IIb, DNET + FCD type IIb), mMCD (2), cysticercosis (1) and dual pathology (1). No underlying pathology was detected in 12 cases (2.5%). Radiopathological concordance was noted in 83%. In 36 cases (7.5%), histopathology detected an unsuspected second pathology that included FCD type III (n = 16) dual pathology (n = 18) and double pathology (n = 2). Further, in four MRI negative cases, histopathology was required for a conclusive diagnosis.
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14
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Xu K, Wang X, Guan Y, Zhao M, Tang C, Zhou J, Zhai F, Wang M, Duan Z, Qi X, Li T, Luan G. Prognostic value of histopathologic pattern for long-term surgical outcomes of 198 patients with confirmed mesial temporal lobe epilepsy. Hum Pathol 2021; 115:47-55. [PMID: 34119513 DOI: 10.1016/j.humpath.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/06/2021] [Indexed: 11/20/2022]
Abstract
Hippocampal sclerosis (HS) is the most common neuropathologic findings in patients with intractable temporal lobe epilepsy (TLE). The international league against epilepsy has proposed a new classification of HS based on pyramidal cell loss on different subfields to facilitate the study of HS pathology in patients after anterior temporal lobectomy (ATL), and the influence of these HS patterns on the prognosis of patients with TLE is contradictory. This study aims to investigate the relationship between different HS subtypes and postoperative seizure outcomes for intractable patients with TLE. From January 2008 to December 2018, we retrospectively reviewed 198 TLE patients with ATL surgery, and all patients had a complete preoperative evaluation, a specimen of hippocampal tissue after surgery, cognitive test after surgery, and more than 2 years of postoperative follow-up. The main findings were as follows: 1) temporal neocortical gray matter heterotopia were more common in the no-HS group; 2) HS type 1 was associated with a longer duration of epilepsy; 3) history of meningitis was the independent predictor of HS type 1; 4) no-HS patients experienced worse postoperative seizure outcomes than those with HS type1 and type 2, whereas no difference in seizure outcomes was obtained between HS type 1 and type 2; 5) no-HS patients were at increased risk for verbal memory decline after left hippocampal resection. The HS subtypes were associated with the prognosis of patients with TLE, and other variables were the predictors of different HS types. `Further study was to identify the HS subtypes by noninvasive evaluation to approve better postoperative outcomes.
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Affiliation(s)
- Ke Xu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Xiongfei Wang
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China; Beijing Key Laboratory of Epilepsy, 100093, China
| | - Yuguang Guan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Meng Zhao
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | | | - Jian Zhou
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Feng Zhai
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Zejun Duan
- Department of Pathlogy, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Xueling Qi
- Department of Pathlogy, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China
| | - Tianfu Li
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China; Beijing Key Laboratory of Epilepsy, 100093, China
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China; Beijing Key Laboratory of Epilepsy, 100093, China.
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15
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Jardim AP, Duarte JTC, Lancellotti CLP, Carrete H, Centeno RS, Scorza CA, Cavalheiro EA, Guaranha MSB, Yacubian EMT. Granule cell dispersion is associated with hippocampal neuronal cell loss, initial precipitating injury, and other clinical features in mesial temporal lobe epilepsy and hippocampal sclerosis. Seizure 2021; 90:60-66. [PMID: 34162493 DOI: 10.1016/j.seizure.2021.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/18/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To characterize a 10-year series of patients with mesial temporal lobe epilepsy (MTLE) and unilateral hippocampal sclerosis (HS) and determine the histopathological characteristic of the association between granule cell dispersion (GCD) and hippocampal neuronal loss. METHODS The study included 108 MTLE/HS patients. Histopathological analyses were performed in NeuN-stained hippocampal sections for HS pattern, neuronal density, dentate gyrus (DG) pathology, and granule cell layer width. Statistical tests investigated the association between DG pathologies and HS patterns, as well as the correlation of DG width with total hippocampal and subfield-specific neuronal densities. RESULTS Fifty-six patients (51.9%) presented right HS. All the four ILAE HS patterns were represented (90 Type 1, 11 Type 2, 2 Type 3, and 5 no-HS). Sixty-seven patients (62.0%) presented GCD, 39 (36.1%) normal DG, and 2 (1.9%) narrow DG. GCD was associated with initial precipitating injury, higher numbers of monthly focal seizures and lifetime bilateral tonic-clonic seizures, longer epilepsy duration, and older age at surgery. GCD was prevalent in all HS patterns, except for Type 2 (81.8% normal versus 18.2% GCD, p = 0.005). GCD was associated with total hippocampal and subfield-specific neuronal loss, except for CA1. DG width correlated with total hippocampal (r = -0.201, p = 0.037) and CA4 neuronal densities (r = -0.299, p = 0.002). Patients with HS Type 1 had better surgical outcomes, with 51 (61.4%) seizure-free in the first year post-surgery. CONCLUSIONS This study confirmed that seizure control in MTLE/HS patients submitted to surgical treatment is comparable worldwide. Moreover, histopathological analyses showed an association between GCD and hippocampal neuronal loss, especially in the CA4 subfield.
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Affiliation(s)
- Anaclara Prada Jardim
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil.
| | - Jeana Torres Corso Duarte
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | | | - Henrique Carrete
- Diagnostic Imaging Sector, Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Ricardo Silva Centeno
- Neurosurgery Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Carla Alessandra Scorza
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Esper Abrão Cavalheiro
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Mirian Salvadori Bittar Guaranha
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Elza Márcia Targas Yacubian
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
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16
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Agudelo Valencia P, van Klink NEC, van 't Klooster MA, Zweiphenning WJEM, Swampillai B, van Eijsden P, Gebbink T, van Zandvoort MJE, Zijlmans M. Are HFOs in the Intra-operative ECoG Related to Hippocampal Sclerosis, Volume and IQ? Front Neurol 2021; 12:645925. [PMID: 33841312 PMCID: PMC8024640 DOI: 10.3389/fneur.2021.645925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is the most common form of refractory focal epilepsy and is often associated with hippocampal sclerosis (HS) and cognitive disturbances. Over the last decade, high frequency oscillations (HFOs) in the intraoperative electrocorticography (ioECoG) have been proposed to be biomarkers for the delineation of epileptic tissue but hippocampal ripples have also been associated with memory consolidation. Healthy hippocampi can show prolonged ripple activity in stereo- EEG. We aimed to identify how the HFO rates [ripples (80–250 Hz, fast ripples (250–500 Hz); prolonged ripples (80–250 Hz, 200–500 ms)] in the pre-resection ioECoG over subtemporal area (hippocampus) and lateral temporal neocortex relate to presence of hippocampal sclerosis, the hippocampal volume quantified on MRI and the severity of cognitive impairment in TLE patients. Volumetric measurement of hippocampal subregions was performed in 47 patients with TLE, who underwent ioECoG. Ripples, prolonged ripples, and fast ripples were visually marked and rates of HFOs were calculated. The intellectual quotient (IQ) before resection was determined. There was a trend toward higher rates of ripples and fast ripples in subtemporal electrodes vs. the lateral neocortex (ripples: 2.1 vs. 1.3/min; fast ripples: 0.9 vs. 0.2/min). Patients with HS showed higher rates of subtemporal fast ripples than other patients (Z = −2.51, p = 0.012). Prolonged ripples were only found in the lateral temporal neocortex. The normalized ratio (smallest/largest) of hippocampal volume was correlated to pre-resection IQ (r = 0.45, p = 0.015). There was no correlation between HFO rates and hippocampal volumes or HFO rates and IQ. To conclude, intra-operative fast ripples were a marker for HS, but ripples and fast ripples were not linearly correlated with either the amount of hippocampal atrophy, nor for pre-surgical IQ.
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Affiliation(s)
- Paula Agudelo Valencia
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Willemiek J E M Zweiphenning
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Banu Swampillai
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Tineke Gebbink
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, University Utrecht, Utrecht, Netherlands.,Stiching Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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17
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Günbey C, Söylemezoğlu F, Bilginer B, Karlı Oğuz K, Akalan N, Topçu M, Turanlı G, Yalnızoğlu D. International consensus classification of hippocampal sclerosis and etiologic diversity in children with temporal lobectomy. Epilepsy Behav 2020; 112:107380. [PMID: 32882628 DOI: 10.1016/j.yebeh.2020.107380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The distribution of hippocampal sclerosis (HS) subtypes, according to the classification of the International League Against Epilepsy (ILAE), has been reported mainly in adult patients. We aimed to review the pathological findings in children who had anterior temporal lobectomy accompanied with amygdalohippocampectomy, in view of the current classification, and evaluate postsurgical outcome with respect to HS subtypes in childhood. METHODS Seventy children who underwent temporal resections for treatment of medically refractory epilepsy, with a minimum follow-up of 2 years, were included; the surgical hippocampus specimens were re-evaluated under the HS ILAE classification. RESULTS Neuropathological evaluations revealed HS type 1 in 38 patients (54.3%), HS type 2 in 2 (2.8%), HS type 3 in 21 patients (30%), and no HS in 9 patients (12.9%). Of 70 patients, 23 (32.9%) had dual pathology, and the most common pattern was HS type 3 with low-grade epilepsy-associated brain tumors (LEAT). The distribution of HS types with respect to age revealed that HS type 3 and no HS subgroups had significantly more patients younger than 12 years, compared with those of HS type 1 (90.5%, 77.8% vs 47.4%, respectively). History of febrile seizures was higher in HS type 1. Prolonged/recurrent febrile seizures were most common in patients 12 years and older, whereas LEAT was the most common etiology in patients under 12 years of age (p < 0.001). Patients with HS type 1 had longer duration of epilepsy and an older age at the time of surgery compared with patients with HS type 3 and no HS (p: 0.031, p: 0.007). At final visit, 74.3% of the patients were seizure-free. Seizure outcome showed no significant difference between pathological subtypes. CONCLUSIONS Our study presents the distribution of HS ILAE subtypes in an exclusively pediatric series along with long-term seizure outcome. The study reveals that the leading pathological HS subgroup in children is HS type 1, similar with adult series. Hippocampal sclerosis type 2 is significantly less in children compared with adults; however, HS type 3 emerges as the second most predominant group because of dual pathology, particularly LEAT. Further studies are required regarding clinicopathological features of isolated HS in pediatric cohort. Seizure-free outcome was favorable and similar in all HS types in children. The proportion of HS types may be better defined in pediatric patients with temporal resections, as the current HS ILAE classification becomes more widely used, and may help reveal the surgical and cognitive outcome with respect to HS types.
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Affiliation(s)
- Ceren Günbey
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Figen Söylemezoğlu
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burçak Bilginer
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kader Karlı Oğuz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nejat Akalan
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meral Topçu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güzide Turanlı
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yalnızoğlu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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18
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Tran S, Mathon B, Morcos-Sauvain E, Lerond J, Navarro V, Bielle F. [Neuropathology of epilepsy]. Ann Pathol 2020; 40:447-460. [PMID: 33092907 DOI: 10.1016/j.annpat.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
The neuropathology of epilepsy aims at diagnosing the cerebral lesions underlying epilepsy that are obtained from epilepsy surgery, or rarely from biopsy or autopsy. The main histopathological and immunohistochemical characteristics of several entities are described: epilepsy-associated hippocampal sclerosis, long-term epilepsy-associated tumours, cortical malformations, vascular malformations, glial scars, encephalitides, and focal neuronal lipofuscinosis. The diagnostic approach, the differential diagnosis and the histochemical and immunohistochemical tools are detailed in order to provide the pathologist with a summarized toolkit to handle the broad range of epileptogenic lesions.
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Affiliation(s)
- Suzanne Tran
- Département de neuropathologie, laboratoire Escourolle, hôpital de la Pitié-Salpêtrière, AP-HP, 46-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Bertrand Mathon
- Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; Service de neurochirurgie, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Elise Morcos-Sauvain
- Département de neuropathologie, laboratoire Escourolle, hôpital de la Pitié-Salpêtrière, AP-HP, 46-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Julie Lerond
- Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; SiRIC curamus (cancer united research associating medicine, university & society), site de recherche intégrée sur le cancer IUC, Sorbonne université, AP-HP, Paris, France
| | - Vincent Navarro
- Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; Service de neurologie, hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France; Centre de référence des épilepsies rares, Paris, France
| | - Franck Bielle
- Département de neuropathologie, laboratoire Escourolle, hôpital de la Pitié-Salpêtrière, AP-HP, 46-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CNRS, Paris brain institute, ICM, Sorbonne université, AP-HP, Paris, France; SiRIC curamus (cancer united research associating medicine, university & society), site de recherche intégrée sur le cancer IUC, Sorbonne université, AP-HP, Paris, France.
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19
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Miyata H, Sudo S, Kuwashige H, Miyao S, Nakamoto H, Kubota Y, Yoshida Y. Dual pathology in a patient with temporal lobe epilepsy associated with neocortical glial scar after brain abscess and end folium sclerosis/hippocampal sclerosis type 3. Neuropathology 2020; 41:42-48. [PMID: 33094499 DOI: 10.1111/neup.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
End folium sclerosis or hippocampal sclerosis (HS) type 3 is often associated with another coexisting epileptogenic lesion (dual pathology); however, the pathogenesis of HS type 3 remains elusive. A 46-year-old man presented with medically intractable focal aware seizures and focal impaired awareness seizures (FIAS) with occasional focal to bilateral tonic-clonic seizures (FBTCS) two years after surgical treatment with extensive cranial reconstruction for a brain abscess in the right temporal lobe associated with intracranial extension of ipsilateral cholesteatoma. Head magnetic resonance imaging (MRI) at age 49 revealed atrophy of the right cerebral hemisphere including the hippocampus and amygdala. The patient's first epilepsy surgery was a lateral temporal lobectomy, in which the mesial temporal structures were preserved because no epileptiform discharge was detected on the intraoperative electrocorticogram. However, FIAS with FBTCS started 15 months after the operation. The second surgery, amygdalohippocampectomy, at age 52, resulted in the patient being seizure-free again for one year before seizures of the right lateral temporal origin recurred. He underwent a third surgery, resection of the Heschl's and supramarginal gyri, at age 53, but he continued to have drug-resistant epilepsy over two years after that. Histopathological examination revealed dual pathology consisting of glial scar in the lateral temporal lobe and ipsilateral HS type 3 with an unusually severe lesion in the subiculum. No significant inflammatory change was observed. The clinicopathological features in the present case indicate that HS developed secondarily in the context of neocortical epilepsy due to glial scar, suggesting a role of repetitive abnormal electrical input from neocortical epileptogenic lesions into the hippocampus finally via the perforant pathway in the pathogenesis of HS type 3. Severe hippocampal atrophy on preoperative MRI together with its silent electrocorticogram recording at initial epilepsy surgery may represent clinically pre-epileptogenic HS in a seizure-free "silent or latent period" before completion of hippocampal epileptogenesis to the extent that clinical epileptic seizures occur.
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Affiliation(s)
- Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Saeko Sudo
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Haruka Kuwashige
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan.,Akita University School of Medicine, Akita, Japan
| | - Satoru Miyao
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.,Department of Neurosurgery, Saiseikai Kurihashi Hospital, Saitama, Japan
| | | | - Yuichi Kubota
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.,Department of Neurosurgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan
| | - Yasuji Yoshida
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
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20
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Liu JYW, Dzurova N, Al-Kaaby B, Mills K, Sisodiya SM, Thom M. Granule Cell Dispersion in Human Temporal Lobe Epilepsy: Proteomics Investigation of Neurodevelopmental Migratory Pathways. Front Cell Neurosci 2020; 14:53. [PMID: 32256318 PMCID: PMC7090224 DOI: 10.3389/fncel.2020.00053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/21/2020] [Indexed: 12/23/2022] Open
Abstract
Granule cell dispersion (GCD) is a common pathological feature observed in the hippocampus of patients with Mesial Temporal Lobe Epilepsy (MTLE). Pathomechanisms underlying GCD remain to be elucidated, but one hypothesis proposes aberrant reactivation of neurodevelopmental migratory pathways, possibly triggered by febrile seizures. This study aims to compare the proteomes of basal and dispersed granule cells in the hippocampus of eight MTLE patients with GCD to identify proteins that may mediate GCD in MTLE. Quantitative proteomics identified 1,882 proteins, of which 29% were found in basal granule cells only, 17% in dispersed only and 54% in both samples. Bioinformatics analyses revealed upregulated proteins in dispersed samples were involved in developmental cellular migratory processes, including cytoskeletal remodeling, axon guidance and signaling by Ras homologous (Rho) family of GTPases (P < 0.01). The expression of two Rho GTPases, RhoA and Rac1, was subsequently explored in immunohistochemical and in situ hybridization studies involving eighteen MTLE cases with or without GCD, and three normal post mortem cases. In cases with GCD, most dispersed granule cells in the outer-granular and molecular layers have an elongated soma and bipolar processes, with intense RhoA immunolabeling at opposite poles of the cell soma, while most granule cells in the basal granule cell layer were devoid of RhoA. A higher percentage of cells expressing RhoA was observed in cases with GCD than without GCD (P < 0.004). In GCD cases, the percentage of cells expressing RhoA was significantly higher in the inner molecular layer than the granule cell layer (P < 0.026), supporting proteomic findings. In situ hybridization studies using probes against RHOA and RAC1 mRNAs revealed fine peri- and nuclear puncta in granule cells of all cases. The density of cells expressing RHOA mRNAs was significantly higher in the inner molecular layer of cases with GCD than without GCD (P = 0.05). In summary, our study has found limited evidence for ongoing adult neurogenesis in the hippocampus of patients with MTLE, but evidence of differential dysmaturation between dispersed and basal granule cells has been demonstrated, and elevated expression of Rho GTPases in dispersed granule cells may contribute to the pathomechanisms underpinning GCD in MTLE.
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Affiliation(s)
- Joan Y W Liu
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,School of Life Sciences, University of Westminster, London, United Kingdom
| | - Natasha Dzurova
- School of Life Sciences, University of Westminster, London, United Kingdom
| | - Batoul Al-Kaaby
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Kevin Mills
- Biological Mass Spectrometry Centre, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Sanjay M Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom.,Chalfont Centre for Epilepsy, Chalfont St Peter, United Kingdom
| | - Maria Thom
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, United Kingdom
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21
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Laser microdissection-based microproteomics of the hippocampus of a rat epilepsy model reveals regional differences in protein abundances. Sci Rep 2020; 10:4412. [PMID: 32157145 PMCID: PMC7064578 DOI: 10.1038/s41598-020-61401-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/18/2020] [Indexed: 01/11/2023] Open
Abstract
Mesial temporal lobe epilepsy (MTLE) is a chronic neurological disorder affecting almost 40% of adult patients with epilepsy. Hippocampal sclerosis (HS) is a common histopathological abnormality found in patients with MTLE. HS is characterised by extensive neuronal loss in different hippocampus sub-regions. In this study, we used laser microdissection-based microproteomics to determine the protein abundances in different regions and layers of the hippocampus dentate gyrus (DG) in an electric stimulation rodent model which displays classical HS damage similar to that found in patients with MTLE. Our results indicate that there are differences in the proteomic profiles of different layers (granule cell and molecular), as well as different regions, of the DG (ventral and dorsal). We have identified new signalling pathways and proteins present in specific layers and regions of the DG, such as PARK7, RACK1, and connexin 31/gap junction. We also found two major signalling pathways that are common to all layers and regions: inflammation and energy metabolism. Finally, our results highlight the utility of high-throughput microproteomics and spatial-limited isolation of tissues in the study of complex disorders to fully appreciate the large biological heterogeneity present in different cell populations within the central nervous system.
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22
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Steve TA, Gargula J, Misaghi E, Nowacki TA, Schmitt LM, Wheatley BM, Gross DW. Hippocampal subfield measurement and ILAE hippocampal sclerosis subtype classification with in vivo 4.7 tesla MRI. Epilepsy Res 2020; 161:106279. [PMID: 32105992 DOI: 10.1016/j.eplepsyres.2020.106279] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Neuropathological studies indicate that hippocampal sclerosis (HS) consists of three subtypes (ILAE types 1-3 HS). However, HS subtypes currently can only be diagnosed by pathological analysis of hippocampal tissue resected during epilepsy surgery or at autopsy. In vivo diagnosis of HS subtypes holds potential to improve our understanding of these variants in the ipsilateral as well as contralateral hippocampus. In this study, we aimed to: i) evaluate the reliability of our histology-derived segmentation protocol when applied to in vivo MRI; and ii) characterize variability of HS subtypes along the hippocampal long axis in patients with epilepsy. METHODS Eleven subjects with unilateral HS were compared with ten healthy controls. We used 4.7 T MRI to acquire high resolution MR Images of the hippocampus in each subject. In vivo MRI-based diagnoses of HS subtypes were then determined in each patient by two methods: i) hippocampal subfield volumetry of the entire hippocampal body; and ii) subfield area analysis at multiple thin slices throughout the hippocampal body. RESULTS Hippocampal body subfield segmentation demonstrated excellent reliability and volumetry of the symptomatic hippocampus revealed abnormalities in all eleven patients. Six subjects demonstrated findings consistent with type 1 HS while five subjects had volumetry-defined atypical HS (two with type 2 HS & three with type 3 HS) in the symptomatic hippocampus, while five subjects were found to have type 3 HS in the contralateral hippocampus. Subfield area analyses demonstrated remarkable variability of HS subtypes along the hippocampal long axis, both ipsilateral and contralateral to the seizure focus. SIGNIFICANCE Our results provide preliminary evidence that determining HS Subtype using in vivo MRI may allow preoperative diagnosis of ILAE HS subtypes. Further studies are essential to determine the pathological correlates of these neuroimaging findings. The heterogeneity of abnormalities observed along the long axis of the hippocampus is consistent with previous autopsy studies and highlights the necessity of studying the entire hippocampus both ipsilateral and contralateral to the seizure focus in these future studies.
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Affiliation(s)
- Trevor A Steve
- Division of Neurology, Department of Medicine, University of Alberta, 11350 83 Ave NW, Edmonton, AB, T6G 2G3, Canada.
| | - Justine Gargula
- Division of Neurology, Department of Medicine, University of Alberta, 11350 83 Ave NW, Edmonton, AB, T6G 2G3, Canada
| | - Ehsan Misaghi
- Division of Neurology, Department of Medicine, University of Alberta, 11350 83 Ave NW, Edmonton, AB, T6G 2G3, Canada
| | - Tomasz A Nowacki
- Division of Neurology, Department of Medicine, University of Alberta, 11350 83 Ave NW, Edmonton, AB, T6G 2G3, Canada
| | - Laura M Schmitt
- Department of Laboratory Medicine & Pathology, University of Alberta, Canada
| | - B Matt Wheatley
- Division of Neurosurgery, Department of Surgery, University of Alberta, Canada
| | - Donald W Gross
- Division of Neurology, Department of Medicine, University of Alberta, 11350 83 Ave NW, Edmonton, AB, T6G 2G3, Canada
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23
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Treit S, Little G, Steve T, Nowacki T, Schmitt L, Wheatley BM, Beaulieu C, Gross DW. Regional hippocampal diffusion abnormalities associated with subfield-specific pathology in temporal lobe epilepsy. Epilepsia Open 2019; 4:544-554. [PMID: 31819910 PMCID: PMC6885671 DOI: 10.1002/epi4.12357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Hippocampal sclerosis (HS) is the most common pathology and best predictor of surgical outcome for medically refractory patients with temporal lobe epilepsy (TLE). Current clinical MRI methods can detect HS, but subfield pathology is poorly characterized, limiting accurate prediction of seizure-free outcomes after surgery. Diffusion tensor imaging (DTI) can probe regional microstructural changes associated with focal hippocampal pathology, but is typically limited by low-resolution whole-brain acquisitions. METHODS High-resolution (1 × 1 × 1 mm3) DTI, T1, and quantitative T2 of the hippocampus was acquired in 18 preoperative TLE patients and 19 healthy controls. Diffusion images were qualitatively assessed for loss of internal architecture, and whole-hippocampus diffusion, volume, and quantitative T2 were compared across groups. Regional hippocampal diffusion abnormalities were examined in all subjects and compared to histology in four subjects who underwent anterior temporal lobectomy. RESULTS High-resolution mean diffusion-weighted images enabled visualization of internal hippocampal architecture, used to visually identify HS with 86% specificity and 93% sensitivity. Mean diffusivity (MD) elevations were regionally heterogenous within the hippocampus and varied across TLE patients. The spatial location of diffusion abnormalities corresponded with the location of focal subfield neuron loss, gliosis, and reduced myelin staining abnormalities identified with postsurgical histology in four subjects who underwent anterior temporal lobectomy. Whole-hippocampus MD and T2 relaxation times were higher, and fractional anisotropy (FA) and volumes were lower in TLE patients relative to controls. Left hippocampus MD correlated with verbal memory in the TLE group. SIGNIFICANCE Visualization of internal architecture and focal diffusion abnormalities on high-resolution diffusion imaging suggests potential clinical utility of diffusion imaging in TLE and may have significant implications for surgical planning and prediction of seizure-free outcomes in individual patients.
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Affiliation(s)
- Sarah Treit
- Department of Biomedical EngineeringFaculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Graham Little
- Department of Biomedical EngineeringFaculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Trevor Steve
- Division of NeurologyFaculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
| | - Tom Nowacki
- Division of NeurologyFaculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
| | - Laura Schmitt
- Department of Laboratory Medicine and PathologyFaculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - B. Matt Wheatley
- Department of SurgeryFaculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Christian Beaulieu
- Department of Biomedical EngineeringFaculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Donald W. Gross
- Division of NeurologyFaculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada
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24
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Aoki Y, Hanai S, Sukigara S, Otsuki T, Saito T, Nakagawa E, Kaido T, Kaneko Y, Takahashi A, Ikegaya N, Iwasaki M, Sugai K, Sasaki M, Goto Y, Oka A, Itoh M. Altered Expression of Astrocyte-Related Receptors and Channels Correlates With Epileptogenesis in Hippocampal Sclerosis. Pediatr Dev Pathol 2019; 22:532-539. [PMID: 31166880 DOI: 10.1177/1093526619855488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hippocampal sclerosis (HS) is one of the major causes of intractable epilepsy. Astrogliosis in epileptic brain is a peculiar condition showing epileptogenesis and is thought to be different from the other pathological conditions. The aim of this study is to investigate the altered expression of astrocytic receptors, which contribute to neurotransmission in the synapse, and channels in HS lesions. METHODS We performed immunohistochemical and immunoblotting analyses of the P2RY1, P2RY2, P2RY4, Kir4.1, Kv4.2, mGluR1, and mGluR5 receptors and channels with the brain samples of 20 HS patients and 4 controls and evaluated the ratio of immunopositive cells and those expression levels. RESULTS The ratio of each immunopositive cell per glial fibrillary acidic protein-positive astrocytes and the expression levels of all 7 astrocytic receptors and channels in HS lesions were significantly increased. We previously described unique astrogliosis in epileptic lesions similar to what was observed in this study. CONCLUSION This phenomenon is considered to trigger activation of the related signaling pathways and then contribute to epileptogenesis. Thus, astrocytes in epileptic lesion may show self-hyperexcitability and contribute to epileptogenesis through the endogenous astrocytic receptors and channels. These findings may suggest novel astrocytic receptor-related targets for the pharmacological treatment of epilepsy.
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Affiliation(s)
- Yoshinori Aoki
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Sae Hanai
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Sayuri Sukigara
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Taisuke Otsuki
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takashi Saito
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan.,Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Eiji Nakagawa
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takanobu Kaido
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuu Kaneko
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akio Takahashi
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Naoki Ikegaya
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masaki Iwasaki
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Kenji Sugai
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masayuki Sasaki
- Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yuichi Goto
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan.,Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Akira Oka
- Department of Pediatrics, The University of Tokyo, Tokyo, Japan
| | - Masayuki Itoh
- Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan.,Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan
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25
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Gimenes AD, Andrade BFD, Pinotti JVP, Oliani SM, Galvis-Alonso OY, Gil CD. Annexin A1-derived peptide Ac 2-26 in a pilocarpine-induced status epilepticus model: anti-inflammatory and neuroprotective effects. J Neuroinflammation 2019; 16:32. [PMID: 30755225 PMCID: PMC6371492 DOI: 10.1186/s12974-019-1414-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/24/2019] [Indexed: 12/18/2022] Open
Abstract
Background The inflammatory process has been described as a crucial mechanism in the pathophysiology of temporal lobe epilepsy. The anti-inflammatory protein annexin A1 (ANXA1) represents an interesting target in the regulation of neuroinflammation through the inhibition of leukocyte transmigration and the release of proinflammatory mediators. In this study, the role of the ANXA1-derived peptide Ac2-26 in an experimental model of status epilepticus (SE) was evaluated. Methods Male Wistar rats were divided into Naive, Sham, SE and SE+Ac2-26 groups, and SE was induced by intrahippocampal injection of pilocarpine. In Sham animals, saline was applied into the hippocampus, and Naive rats were only handled. Three doses of Ac2-26 (1 mg/kg) were administered intraperitoneally (i.p.) after 2, 8 and 14 h of SE induction. Finally, 24 h after the experiment-onset, rats were euthanized for analyses of neuronal lesion and inflammation. Results Pilocarpine induced generalised SE in all animals, causing neuronal damage, and systemic treatment with Ac2-26 decreased neuronal degeneration and albumin levels in the hippocampus. Also, both SE groups showed an intense influx of microglia, which was corroborated by high levels of ionised calcium binding adaptor molecule 1(Iba-1) and monocyte chemoattractant protein-1 (MCP-1) in the hippocampus. Ac2-26 reduced the astrocyte marker (glial fibrillary acidic protein; GFAP) levels, as well as interleukin-1β (IL-1β), interleukin-6 (IL-6) and growth-regulated alpha protein (GRO/KC). These effects of the peptide were associated with the modulation of the levels of formyl peptide receptor 2, a G-protein-coupled receptor that binds to Ac2-26, and the phosphorylated extracellular signal-regulated kinase (ERK) in the hippocampal neurons. Conclusions The data suggest a neuroprotective effect of Ac2-26 in the epileptogenic processes through downregulation of inflammatory mediators and neuronal loss.
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Affiliation(s)
- Alexandre D Gimenes
- Department of Morphology and Genetics, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04023-900, Brazil
| | - Bruna F D Andrade
- Department of Molecular Biology, São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, SP, 15090-000, Brazil
| | - José Victor P Pinotti
- Department of Morphology and Genetics, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04023-900, Brazil
| | - Sonia M Oliani
- Department of Morphology and Genetics, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04023-900, Brazil.,From the Post-Graduation in Biosciences, Instituto de Biociências, Letras e Ciências Exatas, São Paulo State University (IBILCE/UNESP), São José do Rio Preto, SP, 15054-000, Brazil
| | - Orfa Y Galvis-Alonso
- Department of Molecular Biology, São José do Rio Preto School of Medicine (FAMERP), São José do Rio Preto, SP, 15090-000, Brazil
| | - Cristiane D Gil
- Department of Morphology and Genetics, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04023-900, Brazil. .,From the Post-Graduation in Biosciences, Instituto de Biociências, Letras e Ciências Exatas, São Paulo State University (IBILCE/UNESP), São José do Rio Preto, SP, 15054-000, Brazil.
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26
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Kreilkamp BAK, Weber B, Elkommos SB, Richardson MP, Keller SS. Hippocampal subfield segmentation in temporal lobe epilepsy: Relation to outcomes. Acta Neurol Scand 2018; 137:598-608. [PMID: 29572865 PMCID: PMC5969077 DOI: 10.1111/ane.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/24/2022]
Abstract
Objective To investigate the clinical and surgical outcome correlates of preoperative hippocampal subfield volumes in patients with refractory temporal lobe epilepsy (TLE) using a new magnetic resonance imaging (MRI) multisequence segmentation technique. Methods We recruited 106 patients with TLE and hippocampal sclerosis (HS) who underwent conventional T1‐weighted and T2 short TI inversion recovery MRI. An automated hippocampal segmentation algorithm was used to identify twelve subfields in each hippocampus. A total of 76 patients underwent amygdalohippocampectomy and postoperative seizure outcome assessment using the standardized ILAE classification. Semiquantitative hippocampal internal architecture (HIA) ratings were correlated with hippocampal subfield volumes. Results Patients with left TLE had smaller volumes of the contralateral presubiculum and hippocampus‐amygdala transition area compared to those with right TLE. Patients with right TLE had reduced contralateral hippocampal tail volumes and improved outcomes. In all patients, there were no significant relationships between hippocampal subfield volumes and clinical variables such as duration and age at onset of epilepsy. There were no significant differences in any hippocampal subfield volumes between patients who were rendered seizure free and those with persistent postoperative seizure symptoms. Ipsilateral but not contralateral HIA ratings were significantly correlated with gross hippocampal and subfield volumes. Conclusions Our results suggest that ipsilateral hippocampal subfield volumes are not related to the chronicity/severity of TLE. We did not find any hippocampal subfield volume or HIA rating differences in patients with optimal and unfavorable outcomes. In patients with TLE and HS, sophisticated analysis of hippocampal architecture on MRI may have limited value for prediction of postoperative outcome.
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Affiliation(s)
- B. A. K. Kreilkamp
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine; University of Liverpool; Liverpool UK
- Department of Neuroradiology; The Walton Centre NHS Foundation Trust; Liverpool UK
| | - B. Weber
- Department of Epileptology; University of Bonn; Bonn Germany
- Center for Economics and Neuroscience; University of Bonn; Bonn Germany
- Department of NeuroCognition/Imaging; Life& Brain Research Center; Bonn Germany
| | - S. B. Elkommos
- Department of Molecular and Clinical Sciences; St George's, University of London; London UK
| | - M. P. Richardson
- Department of Basic and Clinical Neuroscience; Institute of Psychiatry, Psychology & Neuroscience; King's College London; London UK
- Engineering and Physical Sciences Research Council Centre for Predictive Modelling in Healthcare; University of Exeter; Exeter UK
| | - S. S. Keller
- Department of Molecular and Clinical Pharmacology; Institute of Translational Medicine; University of Liverpool; Liverpool UK
- Department of Neuroradiology; The Walton Centre NHS Foundation Trust; Liverpool UK
- Department of Basic and Clinical Neuroscience; Institute of Psychiatry, Psychology & Neuroscience; King's College London; London UK
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27
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Gillmann C, Coras R, Rössler K, Doerfler A, Uder M, Blümcke I, Bäuerle T. Ultra-high field MRI of human hippocampi: Morphological and multiparametric differentiation of hippocampal sclerosis subtypes. PLoS One 2018; 13:e0196008. [PMID: 29668721 PMCID: PMC5906020 DOI: 10.1371/journal.pone.0196008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/04/2018] [Indexed: 12/23/2022] Open
Abstract
The aim of the present study is to differentiate subtypes of hippocampal sclerosis (HS) using ex vivo ultra-high field magnetic resonance imaging (MRI). Included were 14 surgically resected hippocampi of patients with medically intractable temporal lobe epilepsy. The resected hippocampi were histologically categorized into subtypes of hippocampal sclerosis (HS type 1 (n = 10), HS type 2 (n = 2) and no-HS (n = 2)) and subsequently scanned on a preclinical 7T MRI acquiring T2-weighted morphology, relaxometry and diffusion tensor imaging. On the morphological images, the pyramidal cell layer (PCL) of the hippocampus was segmented and the following parameters were derived: T2 signal intensity, T1-, T2- and T2*-relaxation times, apparent diffusion coefficient (ADC), fractional anisotropy (FA) and mean diffusivity (MD). Furthermore, the area of the PCL was determined, as well as the parameter product which refers to the widths of the PCL parallel and perpendicular to the stratum moleculare. Spearman correlation coefficient was used to demonstrate relationships between MR-parameters and type of sclerosis. In comparison to no-HS specimens, the PCL was significantly narrower in HS type 1 and HS type 2 hippocampi. This narrowing affected the entire cornu ammonis sector (CA) 1 in HS type 1, while it was limited to the upper half of CA1 in direction to CA2 in HS type 2. The parameter product median increased from 0.43 to 1.67 and 2.91 mm2 for HS type 1, HS type 2 and no-HS, respectively. Correlation coefficients were significant for the PCL parameters product (0.73), area (0.71), T2*-time (-0.67), FA (0.65) and ADC (0.55). Our initial results suggest that HS type 1, HS type 2 and no-HS subtypes can be distinguished from each other using ex vivo UHF MRI based on T2-weighted morphologic images and the assessment of the parameter product. Upon clinical translation, UHF-MRI may provide a promising technique for the preoperative differentiation of HS subtypes in patients.
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Affiliation(s)
- Clarissa Gillmann
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | - Roland Coras
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Karl Rössler
- Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Ingmar Blümcke
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Tobias Bäuerle
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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Calderon-Garcidueñas AL, Mathon B, Lévy P, Bertrand A, Mokhtari K, Samson V, Thuriès V, Lambrecq V, Nguyen VHM, Dupont S, Adam C, Baulac M, Clémenceau S, Duyckaerts C, Navarro V, Bielle F. New clinicopathological associations and histoprognostic markers in ILAE types of hippocampal sclerosis. Brain Pathol 2018; 28:644-655. [PMID: 29476662 DOI: 10.1111/bpa.12596] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/06/2018] [Accepted: 01/27/2018] [Indexed: 12/30/2022] Open
Abstract
Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a heterogeneous syndrome. Surgery results in seizure freedom for most pharmacoresistant patients, but the epileptic and cognitive prognosis remains variable. The 2013 International League Against Epilepsy (ILAE) histopathological classification of hippocampal sclerosis (HS) has fostered research to understand MTLE-HS heterogeneity. We investigated the associations between histopathological features (ILAE types, hypertrophic CA4 neurons, granule cell layer alterations, CD34 immunopositive cells) and clinical features (presurgical history, postsurgical outcome) in a monocentric series of 247 MTLE-HS patients treated by surgery. NeuN, GFAP and CD34 immunostainings and a double independent pathological examination were performed. 186 samples were type 1, 47 type 2, 7 type 3 and 7 samples were gliosis only but no neuronal loss (noHS). In the type 1, hypertrophic CA4 neurons were associated with a worse postsurgical outcome and granule cell layer duplication was associated with generalized seizures and episodes of status epilepticus. In the type 2, granule cell layer duplication was associated with generalized seizures. CD34+ stellate cells were more frequent in the type 2, type 3 and in noHS. These cells had a Nestin and SOX2 positive, immature neural immunophenotype. Patients with nodules of CD34+ cells had more frequent dysmnesic auras. CD34+ stellate cells in scarce pattern were associated with higher ratio of normal MRI and of stereo-electroencephalographic studies. CD34+ cells were associated with a trend for a better postsurgical outcome. Among CD34+ cases, we proposed a new entity of BRAF V600E positive HS and we described three hippocampal multinodular and vacuolating neuronal tumors. To conclude, our data identified new clinicopathological associations with ILAE types. They showed the prognostic value of CA4 hypertrophic neurons. They highlighted CD34+ stellate cells and BRAF V600E as biomarkers to further decipher MTLE-HS heterogeneity.
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Affiliation(s)
- Ana Laura Calderon-Garcidueñas
- Department of Neuropathology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France.,Institute of Forensic Medicine, Universidad Veracruzana, Boca del Río, Mexico
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France.,Sorbonne University, UPMC, Univ Paris 06, Paris, France
| | - Pierre Lévy
- Sorbonne University, UPMC, Univ Paris 06, Paris, France.,UPMC and Inserm UMR S 1136 (EPAR team), Département de Santé Publique, Hôpital Tenon, Groupe Hospitalier Universitaire de l'Est Parisien, AP-HP, Paris, France
| | - Anne Bertrand
- Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.,Inria Paris, Aramis project-team, Paris, France.,Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Karima Mokhtari
- Department of Neuropathology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
| | - Véronique Samson
- Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Valérie Thuriès
- Department of Neuropathology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Virginie Lambrecq
- Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.,Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Vi-Huong Michel Nguyen
- Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Sophie Dupont
- Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.,Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France.,Department of Rehabilitation, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Claude Adam
- Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.,Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Michel Baulac
- Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.,Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Stéphane Clémenceau
- Department of Neurosurgery, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Charles Duyckaerts
- Department of Neuropathology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France.,Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
| | - Vincent Navarro
- Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France.,Department of Epileptology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France
| | - Franck Bielle
- Department of Neuropathology, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Paris, France.,Sorbonne University, UPMC, Univ Paris 06, Paris, France.,Brain and Spine Institute (ICM; INSERM, UMRS 1127; CNRS, UMR 7225), Paris, France
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Olivares-Granados G, Ríos-Pelegrina RM, Ruiz-Giménez J, Galdón-Castillo A, Escobar-Delgado T, García del Moral R. Definición clínico-patológica de los subtipos de epilepsia temporal medial con esclerosis del hipocampo. Neurocirugia (Astur) 2018; 29:9-17. [DOI: 10.1016/j.neucir.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/24/2017] [Indexed: 01/02/2023]
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Voets NL, Hodgetts CJ, Sen A, Adcock JE, Emir U. Hippocampal MRS and subfield volumetry at 7T detects dysfunction not specific to seizure focus. Sci Rep 2017; 7:16138. [PMID: 29170537 PMCID: PMC5700920 DOI: 10.1038/s41598-017-16046-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/03/2017] [Indexed: 01/06/2023] Open
Abstract
Ultra high-field 7T MRI offers sensitivity to localize hippocampal pathology in temporal lobe epilepsy (TLE), but has rarely been evaluated in patients with normal-appearing clinical MRI. We applied multimodal 7T MRI to assess if focal subfield atrophy and deviations in brain metabolites characterize epileptic hippocampi. Twelve pre-surgical TLE patients (7 MRI-negative) and age-matched healthy volunteers were scanned at 7T. Hippocampal subfields were manually segmented from 600μm isotropic resolution susceptibility-weighted images. Hippocampal metabolite spectra were acquired to determine absolute concentrations of glutamate, glutamine, myo-inositol, NAA, creatine and choline. We performed case-controls analyses, using permutation testing, to identify abnormalities in hippocampal imaging measures in individual patients, for evaluation against clinical evidence of seizure lateralisation and neuropsychological memory test scores. Volume analyses identified hippocampal subfield atrophy in 9/12 patients (75%), commonly affecting CA3. 7/8 patients had altered metabolite concentrations, most showing reduced glutamine levels (62.5%). However, neither volume nor metabolite deviations consistently lateralized the epileptogenic hippocampus. Rather, lower subiculum volumes and glutamine concentrations correlated with impaired verbal memory performance. Hippocampal subfield and metabolic abnormalities detected at 7T appear to reflect pathophysiological processes beyond epileptogenesis. Despite limited diagnostic contributions, these markers show promise to help elucidate mnemonic processing in TLE.
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Affiliation(s)
- Natalie L Voets
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK. .,Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Carl J Hodgetts
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Arjune Sen
- Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Jane E Adcock
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Kwan BY, Salehi F, Kope R, Lee DH, Sharma M, Hammond R, Burneo JG, Steven D, Peters T, Khan AR. Evaluation of ex-vivo 9.4T MRI in post-surgical specimens from temporal lobe epilepsy patients. J Neuroradiol 2017; 44:377-380. [DOI: 10.1016/j.neurad.2017.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/03/2017] [Accepted: 05/25/2017] [Indexed: 12/28/2022]
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32
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Comper SM, Jardim AP, Corso JT, Gaça LB, Noffs MHS, Lancellotti CLP, Cavalheiro EA, Centeno RS, Yacubian EMT. Impact of hippocampal subfield histopathology in episodic memory impairment in mesial temporal lobe epilepsy and hippocampal sclerosis. Epilepsy Behav 2017; 75:183-189. [PMID: 28873362 DOI: 10.1016/j.yebeh.2017.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/06/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of the study was to analyze preoperative visual and verbal episodic memories in a homogeneous series of patients with mesial temporal lobe epilepsy (MTLE) and unilateral hippocampal sclerosis (HS) submitted to corticoamygdalohippocampectomy and its association with neuronal cell density of each hippocampal subfield. METHODS The hippocampi of 72 right-handed patients were collected and prepared for histopathological examination. Hippocampal sclerosis patterns were determined, and neuronal cell density was calculated. Preoperatively, two verbal and two visual memory tests (immediate and delayed recalls) were applied, and patients were divided into two groups, left and right MTLE (36/36). RESULTS There were no statistical differences between groups regarding demographic and clinical data. Cornu Ammonis 4 (CA4) neuronal density was significantly lower in the right hippocampus compared with the left (p=0.048). The groups with HS presented different memory performance - the right HS were worse in visual memory test [Complex Rey Figure, immediate (p=0.001) and delayed (p=0.009)], but better in one verbal task [RAVLT delayed (p=0.005)]. Multiple regression analysis suggested that the verbal memory performance of the group with left HS was explained by CA1 neuronal density since both tasks were significantly influenced by CA1 [Logical Memory immediate recall (p=0.050) and Logical Memory and RAVLT delayed recalls (p=0.004 and p=0.001, respectively)]. For patients with right HS, both CA1 subfield integrity (p=0.006) and epilepsy duration (p=0.012) explained Complex Rey Figure immediate recall performance. Ultimately, epilepsy duration also explained the performance in the Complex Rey Figure delayed recall (p<0.001). SIGNIFICANCE Cornu Ammonis 1 (CA1) hippocampal subfield was related to immediate and delayed recalls of verbal memory tests in left HS, while CA1 and epilepsy duration were associated with visual memory performance in patients with right HS.
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Affiliation(s)
- Sandra Mara Comper
- Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Anaclara Prada Jardim
- Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Jeana Torres Corso
- Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Larissa Botelho Gaça
- Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Helena Silva Noffs
- Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Esper Abrão Cavalheiro
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ricardo Silva Centeno
- Neurosurgery Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elza Márcia Targas Yacubian
- Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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33
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Follow-up Case Report: Bumetanide Can Control Seizural Activity in Temporal Lobe Epilepsy Patient. ARCHIVES OF NEUROSCIENCE 2017. [DOI: 10.5812/archneurosci.58681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Development of a histologically validated segmentation protocol for the hippocampal body. Neuroimage 2017; 157:219-232. [PMID: 28587896 DOI: 10.1016/j.neuroimage.2017.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/30/2017] [Accepted: 06/02/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Recent findings have demonstrated that hippocampal subfields can be selectively affected in different disease states, which has led to efforts to segment the human hippocampus with in vivo magnetic resonance imaging (MRI). However, no studies have examined the histological accuracy of subfield segmentation protocols. The presence of MRI-visible anatomical landmarks with known correspondence to histology represents a fundamental prerequisite for in vivo hippocampal subfield segmentation. In the present study, we aimed to: 1) develop a novel method for hippocampal body segmentation, based on two MRI-visible anatomical landmarks (stratum lacunosum moleculare [SLM] & dentate gyrus [DG]), and assess its accuracy in comparison to the gold standard direct histological measurements; 2) quantify the accuracy of two published segmentation strategies in comparison to the histological gold standard; and 3) apply the novel method to ex vivo MRI and correlate the results with histology. METHODS Ultra-high resolution ex vivo MRI was performed on six whole cadaveric hippocampal specimens, which were then divided into 22 blocks and histologically processed. The hippocampal bodies were segmented into subfields based on histological criteria and subfield boundaries and areas were directly measured. A novel method was developed using mean percentage of the total SLM distance to define subfield boundaries. Boundary distances and subfield areas on histology were then determined using the novel method and compared to the gold standard histological measurements. The novel method was then used to determine ex vivo MRI measures of subfield boundaries and areas, which were compared to histological measurements. RESULTS For direct histological measurements, the mean percentages of total SLM distance were: Subiculum/CA1 = 9.7%, CA1/CA2 = 78.4%, CA2/CA3 = 97.5%. When applied to histology, the novel method provided accurate measures for CA1/CA2 (ICC = 0.93) and CA2/CA3 (ICC = 0.97) boundaries, but not for the Subiculum/CA1 (ICC = -0.04) boundary. Accuracy was poorer using previous techniques for CA1/CA2 (maximum ICC = 0.85) and CA2/CA3 (maximum ICC = 0.88), with the previously reported techniques also performing poorly in defining the Subiculum/CA1 boundary (maximum ICC = 0.00). Ex vivo MRI measurements using the novel method were linearly related to direct measurements of SLM length (r2 = 0.58), CA1/CA2 boundary (r2 = 0.39) and CA2/CA3 boundary (r2 = 0.47), but not for Subiculum/CA1 boundary (r2 = 0.01). Subfield areas measured with the novel method on histology and ex vivo MRI were linearly related to gold standard histological measures for CA1, CA2, and CA3/CA4/DG. CONCLUSIONS In this initial proof of concept study, we used ex vivo MRI and histology of cadaveric hippocampi to develop a novel segmentation protocol for the hippocampal body. The novel method utilized two anatomical landmarks, SLM & DG, and provided accurate measurements of CA1, CA2, and CA3/CA4/DG subfields in comparison to the gold standard histological measurements. The relationships demonstrated between histology and ex vivo MRI supports the potential feasibility of applying this method to in vivo MRI studies.
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Gales JM, Jehi L, Nowacki A, Prayson RA. The role of histopathologic subtype in the setting of hippocampal sclerosis–associated mesial temporal lobe epilepsy. Hum Pathol 2017; 63:79-88. [DOI: 10.1016/j.humpath.2017.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/02/2017] [Accepted: 02/23/2017] [Indexed: 11/17/2022]
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Prada Jardim A, Liu J, Baber J, Michalak Z, Reeves C, Ellis M, Novy J, de Tisi J, McEvoy A, Miserocchi A, Targas Yacubian EM, Sisodiya S, Thompson P, Thom M. Characterising subtypes of hippocampal sclerosis and reorganization: correlation with pre and postoperative memory deficit. Brain Pathol 2017; 28:143-154. [PMID: 28380661 PMCID: PMC5893935 DOI: 10.1111/bpa.12514] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/28/2017] [Indexed: 01/16/2023] Open
Abstract
Neuropathological subtypes of hippocampal sclerosis (HS) in temporal lobe epilepsy (The 2013 International League Against Epilepsy classification) are based on the qualitative assessment of patterns of neuronal loss with NeuN. In practice, some cases appear indeterminate between type 1 (CA1 and CA4 loss) and type 2 HS (CA1 loss) and we predicted that MAP2 would enable a more stringent classification. HS subtypes, as well as the accompanying alteration of axonal networks, regenerative capacity and neurodegeneration have been previously correlated with outcome and memory deficits and may provide prognostic clinical information. We selected 92 cases: 52 type 1 HS, 15 type 2 HS, 18 indeterminate‐HS and 7 no‐HS. Quantitative analysis was carried out on NeuN and MAP2 stained sections and a labeling index (LI) calculated for six hippocampal subfields. We also evaluated hippocampal regenerative activity (MCM2, nestin, olig2, calbindin), degeneration (AT8/phosphorylated tau) and mossy‐fiber pathway re‐organization (ZnT3). Pathology measures were correlated with clinical epilepsy history, memory and naming test scores and postoperative outcomes, at 1 year following surgery. MAP2 LI in indeterminate‐HS was statistically similar to type 2 HS but this clustering was not shown with NeuN. Moderate verbal and visual memory deficits were noted in all HS types, including 54% and 69% of type 2 HS. Memory deficits correlated with several pathology factors including lower NeuN or MAP2 LI in CA4, CA1, dentate gyrus (DG) and subiculum and poor preservation of the mossy fiber pathway. Decline in memory at 1 year associated with AT8 labeling in the subiculum and DG but not HS type. We conclude that MAP2 is a helpful addition in the classification of HS in some cases. Classification of HS subtype, however, did not significantly correlate with outcome or pre‐ or postoperative memory dysfunction, which was associated with multiple pathology factors including hippocampal axonal pathways, regenerative capacity and degenerative changes.
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Affiliation(s)
- Anaclara Prada Jardim
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, UNIFESP, Sao Paulo, Brazil
| | - Joan Liu
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
| | - Jack Baber
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK
| | - Zuzanna Michalak
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
| | - Cheryl Reeves
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
| | - Matthew Ellis
- Departments of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
| | - Jan Novy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK.,Service de Neurologie, Département des Neurosciences Cliniques, CHUV, University of Lausanne, Switzerland
| | - Jane de Tisi
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK
| | - Andrew McEvoy
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
| | - Anna Miserocchi
- Departments of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
| | | | - Sanjay Sisodiya
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK.,Epilepsy Society, Epilepsy Society Research Centre, Buckinghamshire, SL9 0RJ, UK
| | - Pamela Thompson
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK.,Epilepsy Society, Epilepsy Society Research Centre, Buckinghamshire, SL9 0RJ, UK
| | - Maria Thom
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London, WCN1BG, UK.,Departments of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WCN1BG, UK
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Abstract
Epilepsy is one of the most common neurologic disorders, affecting about 50 million people worldwide. The disease is characterized by recurrent seizures, which are due to aberrant neuronal networks resulting in synchronous discharges. The term epilepsy encompasses a large spectrum of syndromes and diseases with different etiopathogenesis. The recent development of imaging and epilepsy surgery techniques is now enabling the identification of structural abnormalities that are part of the epileptic network, and the removal of these lesions may result in control of seizures. Access of this clinically well-characterized neurosurgical material has provided neuropathologists with the opportunity to study a variety of structural brain abnormalities associated with epilepsy, by combining traditional routine histopathologic methods with molecular genetics and functional analysis of the resected tissue. This approach has contributed greatly to a better diagnosis and classification of these structural lesions, and has provided important new insights into their pathogenesis and epileptogenesis. The present chapter provides a detailed description of the large spectrum of histopathologic findings encountered in epilepsy surgery patients, addressing in particular the nonneoplastic pathologies, including hippocampal sclerosis, malformations of cortical development, Sturge-Weber syndrome, and Rasmussen encephalitis, and reviews current knowledge regarding the underlying molecular pathomechanisms and cellular mechanisms mediating hyperexcitability.
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Affiliation(s)
- Eleonora Aronica
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, the Netherlands.
| | - Angelika Mühlebner
- Department of Neuropathology, Academic Medical Center and Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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Keller SS, Glenn GR, Weber B, Kreilkamp BAK, Jensen JH, Helpern JA, Wagner J, Barker GJ, Richardson MP, Bonilha L. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy. Brain 2017; 140:68-82. [PMID: 28031219 PMCID: PMC5226062 DOI: 10.1093/brain/aww280] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 09/10/2016] [Accepted: 09/26/2016] [Indexed: 11/12/2022] Open
Abstract
Approximately one in every two patients with pharmacoresistant temporal lobe epilepsy will not be rendered completely seizure-free after temporal lobe surgery. The reasons for this are unknown and are likely to be multifactorial. Quantitative volumetric magnetic resonance imaging techniques have provided limited insight into the causes of persistent postoperative seizures in patients with temporal lobe epilepsy. The relationship between postoperative outcome and preoperative pathology of white matter tracts, which constitute crucial components of epileptogenic networks, is unknown. We investigated regional tissue characteristics of preoperative temporal lobe white matter tracts known to be important in the generation and propagation of temporal lobe seizures in temporal lobe epilepsy, using diffusion tensor imaging and automated fibre quantification. We studied 43 patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis and 44 healthy controls. Patients underwent preoperative imaging, amygdalohippocampectomy and postoperative assessment using the International League Against Epilepsy seizure outcome scale. From preoperative imaging, the fimbria-fornix, parahippocampal white matter bundle and uncinate fasciculus were reconstructed, and scalar diffusion metrics were calculated along the length of each tract. Altogether, 51.2% of patients were rendered completely seizure-free and 48.8% continued to experience postoperative seizure symptoms. Relative to controls, both patient groups exhibited strong and significant diffusion abnormalities along the length of the uncinate bilaterally, the ipsilateral parahippocampal white matter bundle, and the ipsilateral fimbria-fornix in regions located within the medial temporal lobe. However, only patients with persistent postoperative seizures showed evidence of significant pathology of tract sections located in the ipsilateral dorsal fornix and in the contralateral parahippocampal white matter bundle. Using receiver operating characteristic curves, diffusion characteristics of these regions could classify individual patients according to outcome with 84% sensitivity and 89% specificity. Pathological changes in the dorsal fornix were beyond the margins of resection, and contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Furthermore, diffusion characteristics of the ipsilateral uncinate could classify patients from controls with a sensitivity of 98%; importantly, by co-registering the preoperative fibre maps to postoperative surgical lacuna maps, we observed that the extent of uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network. These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures.
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Affiliation(s)
- Simon S Keller
- 1 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
- 2 Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- 3 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - G Russell Glenn
- 4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, USA
- 5 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, USA
- 6 Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Bernd Weber
- 7 Department of Epileptology, University of Bonn, Germany
- 8 Department of Neurocognition / Imaging, Life and Brain Research Centre, Bonn, Germany
| | - Barbara A K Kreilkamp
- 1 Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
- 2 Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Jens H Jensen
- 4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, USA
- 5 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, USA
| | - Joseph A Helpern
- 4 Center for Biomedical Imaging, Medical University of South Carolina, Charleston, USA
- 5 Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, USA
- 6 Department of Neurosciences, Medical University of South Carolina, Charleston, USA
| | - Jan Wagner
- 7 Department of Epileptology, University of Bonn, Germany
- 8 Department of Neurocognition / Imaging, Life and Brain Research Centre, Bonn, Germany
- 9 Department of Neurology, Epilepsy Centre Hessen-Marburg, University of Marburg Medical Centre, Germany
| | - Gareth J Barker
- 10 Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Mark P Richardson
- 3 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- 11 Engineering and Physical Sciences Research Council Centre for Predictive Modelling in Healthcare, University of Exeter, UK
| | - Leonardo Bonilha
- 12 Department of Neurology, Medical University of South Carolina, Charleston, USA
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Hippocampal atrophy on MRI is predictive of histopathological patterns and surgical prognosis in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Res 2016; 128:169-175. [DOI: 10.1016/j.eplepsyres.2016.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/04/2016] [Accepted: 10/24/2016] [Indexed: 01/19/2023]
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Tezer FI, Xasiyev F, Soylemezoglu F, Bilginer B, Oguz KK, Saygi S. Clinical and electrophysiological findings in mesial temporal lobe epilepsy with hippocampal sclerosis, based on the recent histopathological classifications. Epilepsy Res 2016; 127:50-54. [DOI: 10.1016/j.eplepsyres.2016.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/04/2016] [Accepted: 08/14/2016] [Indexed: 11/25/2022]
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Santyr BG, Goubran M, Lau JC, Kwan BYM, Salehi F, Lee DH, Mirsattari SM, Burneo JG, Steven DA, Parrent AG, de Ribaupierre S, Hammond RR, Peters TM, Khan AR. Investigation of hippocampal substructures in focal temporal lobe epilepsy with and without hippocampal sclerosis at 7T. J Magn Reson Imaging 2016; 45:1359-1370. [PMID: 27564217 DOI: 10.1002/jmri.25447] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/11/2016] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To provide a more detailed investigation of hippocampal subfields using 7T magnetic resonance imaging (MRI) for the identification of hippocampal sclerosis in temporal lobe epilepsy (TLE). MATERIALS AND METHODS Patients (n = 13) with drug-resistant TLE previously identified by conventional imaging as having hippocampal sclerosis (HS) or not (nine without HS, four HS) and 20 age-matched healthy controls were scanned and compared using a 7T MRI protocol. Using a manual segmentation scheme to delineate hippocampal subfields, subfield-specific volume changes and apparent transverse relaxation rate ( R2*) were studied between the two groups. In addition, qualitative assessment at 7T and clinical outcomes were correlated with measured subfield changes. RESULTS Volumetry of the hippocampus at 7T in HS patients revealed significant ipsilateral subfield atrophy in CA1 (P = 0.001) and CA4+DG (P < 0.001). Volumetry also uncovered subfield atrophy in 33% of patients without HS, which had not been detected using conventional imaging. R2* was significantly lower in the CA4+DG subfields (P = 0.001) and the whole hippocampus (P = 0.029) of HS patients compared to controls but not significantly lower than the group without HS (P = 0.077, P = 0.109). No correlation was found between quantitative volumetry and qualitative assessment as well as surgical outcomes (Sub, P = 0.495, P = 0.567, P = 0.528; CA1, P = 0.104 ± 0.171, P = 0.273, P = 0.554; CA2+CA3, P = 0.517, P = 0.952, P = 0.130 ± 0.256; CA4+DG, P = 0.052 ± 0.173, P = 0.212, P = 0.124 ± 0.204; WholeHipp, P = 0.187, P = 0.132 ± 0.197, P = 0.628). CONCLUSION These preliminary findings indicate that hippocampal subfield volumetry assessed at 7T is capable of identifying characteristic patterns of hippocampal atrophy in HS patients; however, difficulty remains in using imaging to identify hippocampal pathologies in cases without HS. LEVEL OF EVIDENCE 2 J. MAGN. RESON. IMAGING 2017;45:1359-1370.
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Affiliation(s)
- Brendan G Santyr
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada
| | - Maged Goubran
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Jonathan C Lau
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin Y M Kwan
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Fateme Salehi
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Donald H Lee
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Seyed M Mirsattari
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - David A Steven
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Andrew G Parrent
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Sandrine de Ribaupierre
- Department of Clinical Neurological Sciences - London Health Sciences Centre, London, Ontario, Canada
| | - Robert R Hammond
- Department of Pathology and Laboratory Medicine - London Health Sciences Centre, London, Ontario, Canada
| | - Terry M Peters
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
| | - Ali R Khan
- Schulich School of Medicine and Dentistry - Western University, London, Ontario, Canada.,Departments of Medical Biophysics and Medical Imaging - Western University, London, Ontario, Canada
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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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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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Goubran M, Bernhardt BC, Cantor‐Rivera D, Lau JC, Blinston C, Hammond RR, de Ribaupierre S, Burneo JG, Mirsattari SM, Steven DA, Parrent AG, Bernasconi A, Bernasconi N, Peters TM, Khan AR. In vivo MRI signatures of hippocampal subfield pathology in intractable epilepsy. Hum Brain Mapp 2016; 37:1103-19. [PMID: 26679097 PMCID: PMC6867266 DOI: 10.1002/hbm.23090] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/20/2015] [Accepted: 12/05/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Our aim is to assess the subfield-specific histopathological correlates of hippocampal volume and intensity changes (T1, T2) as well as diff!usion MRI markers in TLE, and investigate the efficacy of quantitative MRI measures in predicting histopathology in vivo. EXPERIMENTAL DESIGN We correlated in vivo volumetry, T2 signal, quantitative T1 mapping, as well as diffusion MRI parameters with histological features of hippocampal sclerosis in a subfield-specific manner. We made use of on an advanced co-registration pipeline that provided a seamless integration of preoperative 3 T MRI with postoperative histopathological data, on which metrics of cell loss and gliosis were quantitatively assessed in CA1, CA2/3, and CA4/DG. PRINCIPAL OBSERVATIONS MRI volumes across all subfields were positively correlated with neuronal density and size. Higher T2 intensity related to increased GFAP fraction in CA1, while quantitative T1 and diffusion MRI parameters showed negative correlations with neuronal density in CA4 and DG. Multiple linear regression analysis revealed that in vivo multiparametric MRI can predict neuronal loss in all the analyzed subfields with up to 90% accuracy. CONCLUSION Our results, based on an accurate co-registration pipeline and a subfield-specific analysis of MRI and histology, demonstrate the potential of MRI volumetry, diffusion, and quantitative T1 as accurate in vivo biomarkers of hippocampal pathology.
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Affiliation(s)
- Maged Goubran
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
| | - Boris C. Bernhardt
- Neuroimaging of Epilepsy LaboratoryMcConnell Brain Imaging Center, Montreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Diego Cantor‐Rivera
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
| | - Jonathan C. Lau
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Charlotte Blinston
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
| | - Robert R. Hammond
- Department of PathologyDivision of NeuropathologyLondonOntarioCanada
| | - Sandrine de Ribaupierre
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
| | - Jorge G. Burneo
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Seyed M. Mirsattari
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
- Department of Medical ImagingWestern UniversityLondonOntarioCanada
| | - David A. Steven
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Andrew G. Parrent
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy LaboratoryMcConnell Brain Imaging Center, Montreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy LaboratoryMcConnell Brain Imaging Center, Montreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Terry M. Peters
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
| | - Ali R. Khan
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
- Department of Medical ImagingWestern UniversityLondonOntarioCanada
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Choe M, Cortés E, Vonsattel JPG, Kuo SH, Faust PL, Louis ED. Purkinje cell loss in essential tremor: Random sampling quantification and nearest neighbor analysis. Mov Disord 2016; 31:393-401. [PMID: 26861543 DOI: 10.1002/mds.26490] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/20/2015] [Accepted: 10/26/2015] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Purkinje cell loss has been documented in some, although not all, postmortem studies of essential tremor. Hence, there is considerable controversy concerning the presence of Purkinje cell loss in this disease. To date, few studies have been performed. METHODS Over the past 8 years, we have assembled 50 prospectively studied cases and 25 age-matched controls; none were reported in our previous large series of 33 essential tremor and 21 controls. In addition to methods used in previous studies, the current study used a random sampling approach to quantify Purkinje cells along the Purkinje cell layer with a mean of 217 sites examined in each specimen, allowing for extensive sampling of the Purkinje cell layer within the section. For the first time, we also quantified the distance between Purkinje cell bodies-a nearest neighbor analysis. RESULTS In the Purkinje cell count data collected from fifteen 100 × fields, cases had lower counts than controls in all three counting criteria (cell bodies, nuclei, and nucleoli; all P < 0.001). Purkinje cell linear density was also lower in cases than controls (all P < 0.001). Purkinje cell linear density obtained by random sampling was similarly lower in cases than controls in all three counting criteria (cell bodies, nuclei, and nucleoli, all P ≤ 0.005). In agreement with the quantitative Purkinje cell counts, the mean distance from one Purkinje cell body to another Purkinje cell body along the Purkinje cell layer was greater in cases than controls (P = 0.002). CONCLUSIONS These data provide support for the neurodegeneration of cerebellar Purkinje cells in essential tremor.
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Affiliation(s)
- Matthew Choe
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Etty Cortés
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jean-Paul G Vonsattel
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA.,Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Chronic Disease Epidemiology, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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46
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Elkommos S, Weber B, Niehusmann P, Volmering E, Richardson MP, Goh YY, Marson AG, Elger C, Keller SS. Hippocampal internal architecture and postoperative seizure outcome in temporal lobe epilepsy due to hippocampal sclerosis. Seizure 2016; 35:65-71. [PMID: 26803053 PMCID: PMC4773400 DOI: 10.1016/j.seizure.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/11/2015] [Accepted: 01/05/2016] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Semi-quantitative analysis of hippocampal internal architecture (HIA) on MRI has been shown to be a reliable predictor of the side of seizure onset in patients with temporal lobe epilepsy (TLE). In the present study, we investigated the relationship between postoperative seizure outcome and preoperative semi-quantitative measures of HIA. METHODS We determined HIA on high in-plane resolution preoperative T2 short tau inversion recovery MR images in 79 patients with presumed unilateral mesial TLE (mTLE) due to hippocampal sclerosis (HS) who underwent amygdalohippocampectomy and postoperative follow up. HIA was investigated with respect to postoperative seizure freedom, neuronal density determined from resected hippocampal specimens, and conventionally acquired hippocampal volume. RESULTS HIA ratings were significantly related to some neuropathological features of the resected hippocampus (e.g. neuronal density of selective CA regions, Wyler grades), and bilaterally with preoperative hippocampal volume. However, there were no significant differences in HIA ratings of the to-be-resected or contralateral hippocampus between patients rendered seizure free (ILAE 1) compared to those continuing to experience seizures (ILAE 2-5). CONCLUSIONS This work indicates that semi-quantitative assessment of HIA on high-resolution MRI provides a surrogate marker of underlying histopathology, but cannot prospectively distinguish between patients who will continue to experience postoperative seizures and those who will be rendered seizure free. The predictive power of HIA for postoperative seizure outcome in non-lesional patients with TLE should be explored.
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Affiliation(s)
- Samia Elkommos
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | - Bernd Weber
- Department of Epileptology, University of Bonn, Germany; Department of Neurocognition/Imaging, Life&Brain Research Centre, Bonn, Germany
| | - Pitt Niehusmann
- Department of Neuropathology, University of Bonn, Germany; Department of Neuropathology, Oslo University Hospital, Norway
| | | | - Mark P Richardson
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Yen Y Goh
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK
| | | | - Simon S Keller
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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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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48
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Kim JB, Suh SI, Kim JH. Volumetric and shape analysis of hippocampal subfields in unilateral mesial temporal lobe epilepsy with hippocampal atrophy. Epilepsy Res 2015; 117:74-81. [DOI: 10.1016/j.eplepsyres.2015.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/11/2015] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
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49
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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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50
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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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