1
|
Liu Q, Cai L, Sun Y, Wang Y, Yu H, Liu C, Wang H, Zhang S, Gong J. Epilepsy Outcome and Pathology Analysis for Ganglioglioma: A Series of 51 Pediatric Patients. Pediatr Neurol 2023; 149:127-133. [PMID: 37879136 DOI: 10.1016/j.pediatrneurol.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The postoperative epilepsy outcome and clinicopathological features in children with ganglioglioma (GG) are not well understood. METHODS Data from 51 consecutive pediatric patients diagnosed with GGs who underwent surgery were collected. The correlations between the expression of CD34 and BRAF V600E mutations and clinical features were analyzed. The related factors affecting the outcome of epilepsy were analyzed. RESULTS The average follow-up was 44.2 months, and 48 patients were seizure-free. A high proportion of BRAF V600E mutation (78.8%) and CD34 expression (77.8%) was detected in GG. The onset age of epilepsy with the BRAF V600E mutation was earlier than that without. The expression of CD34 increased with the age of onset, the duration of epilepsy, and the age of operation. Focal cortical dysplasia (FCD) I was found in 62.7% of patients, and FCD II was found in 11.8% of patients approximately in the cortex surrounding GG. There was no significant correlation between the outcome of epilepsy and BRAF V600E mutation, CD34 expression, and combination with FCD. CONCLUSIONS The overall outcome of GG and epilepsy in children is optimistic, and the outcome is not closely related to the presence of BRAF V600E mutation and CD34 (+). The FCD surrounding GG could be type I or type II. Incomplete resection of the surrounding FCD has the risk of unsatisfactory control of epilepsy. Children with the BRAF V600E mutation may be prone to early-onset epilepsy. The expression of CD34 is more likely to be detected in children with older age and a long duration of epilepsy.
Collapse
Affiliation(s)
- Qingzhu Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Lixin Cai
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yu Sun
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Yao Wang
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Hao Yu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Chang Liu
- Pediatric Epilepsy Center, Peking University First Hospital, Beijing, China
| | - Hui Wang
- Department of Nephrology, Peking University First Hospital, Beijing, China
| | - Shuang Zhang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Jian Gong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
2
|
Martinoni M, Fabbri VP, La Corte E, Zucchelli M, Toni F, Asioli S, Giannini C. Glioneuronal and Neuronal Tumors of the Central Nervous System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:253-280. [PMID: 37452941 DOI: 10.1007/978-3-031-23705-8_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Glioneuronal and neuronal tumors (GNTs) are rare neoplasms composed of neural and glial elements frequently located in the temporal lobe. Epilepsy is the main symptom and diagnosis mostly occurs before adulthood. The great majority of GNTs are WHO grade I tumors, but anaplastic transformations and forms exist. Their common association with focal cortical dysplasia is well recognized and should be taken into consideration during neurophysiological presurgical and surgical planning since the aim of surgery should be the removal of the tumor and of the entire epileptogenic zone according to anatomo-electrophysiological findings. Surgery still remains the cornerstone of symptomatic GNT, while radiotherapy, chemotherapy, and new target therapies are generally reserved for anaplastic, unresectable, or evolving tumors. Furthermore, since many GNTs show overlapping clinical and neuroradiological features, the definition of specific histopathological, genetic, and molecular characteristics is crucial. Epileptological, oncological, neurosurgical, and pathological issues of these tumors make a multidisciplinary management mandatory.
Collapse
Affiliation(s)
- Matteo Martinoni
- Division of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Viscardo Paolo Fabbri
- Surgical Pathology Section, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Emanuele La Corte
- Division of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Toni
- Division of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Programma di neuroradiologia con tecniche ad elevata complessità, IRCCS Istituto delle Scienze Neurologiche di Bologna ETC, Bologna, Italy
| | - Sofia Asioli
- Surgical Pathology Section, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM) - Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Caterina Giannini
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Anatomic Pathology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
3
|
Joris V, Ribeiro Vaz JG, Lelotte J, Duprez T, Raftopoulos C. Large Epileptogenic Type IIIb Dysplasia: A Radiological and Anatomopathological Challenge. World Neurosurg 2019; 129:330-333. [DOI: 10.1016/j.wneu.2019.06.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 01/12/2023]
|
4
|
Giulioni M, Marucci G, Cossu M, Tassi L, Bramerio M, Barba C, Buccoliero AM, Vornetti G, Zenesini C, Consales A, De Palma L, Villani F, Di Gennaro G, Vatti G, Zamponi N, Colicchio G, Marras CE. CD34 Expression in Low-Grade Epilepsy-Associated Tumors: Relationships with Clinicopathologic Features. World Neurosurg 2018; 121:e761-e768. [PMID: 30308344 DOI: 10.1016/j.wneu.2018.09.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To analyze relationships between CD34 expression and several demographic, clinical, and pathologic features in patients with histopathologic evidence of low-grade epilepsy-associated tumors who underwent epilepsy surgery. METHODS A retrospective study enrolling 187 patients with low-grade epilepsy-associated tumors who underwent surgery between January 2009 and June 2015 at 8 Italian epilepsy surgery centers was conducted. All cases were histologically diagnosed according to the World Health Organization classification of central nervous system tumors. Univariate and multivariate analyses were performed to identify variables associated with CD34 expression. RESULTS Of 187 patients, 95 (50.8%) were CD34 positive. Tumor type and duration of epilepsy were independently associated with CD34 expression on multivariate analysis. Ganglioglioma and pleomorphic xanthoastrocytoma were the histologic types with the strongest association with CD34 positivity with an odds ratio of 9.2 and 10.4, respectively, compared with dysembryoplastic neuroepithelial tumors. Patients with a duration of epilepsy >10 years had a significantly greater likelihood to show CD34 expression, with an odds ratio of 2.8 compared with patients with a duration of epilepsy <2 years. On univariate analysis, CD34 expression appeared to be significantly related to older age at surgery, higher antiepileptic drug intake, and female sex. CONCLUSIONS CD34 expression holds promise as a useful biomolecular marker for patients with low-grade epilepsy-associated tumors with evidence of a link with clinicopathologic features. This study confirmed the association between CD34 expression and tumor type and demonstrated a significantly higher probability of CD34 expression in patients with longer duration of epilepsy, independent of histology.
Collapse
Affiliation(s)
- Marco Giulioni
- UOC Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| | - Gianluca Marucci
- Anatomic Pathology Unit, Azienda Unità Sanitaria Locale di Bologna, Bologna, Italy; Neuropathology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy
| | - Massimo Cossu
- Claudio Munari Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Tassi
- Claudio Munari Center for Epilepsy Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Manuela Bramerio
- Service of Pathology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carmen Barba
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Anna Maria Buccoliero
- Pathology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Gianfranco Vornetti
- UOC Neurochirurgia, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- Unità di Epidemiologia e Biostatistica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandro Consales
- Department of Pediatric Neurosurgery, Istituto Giannina Gaslini, Genoa, Italy
| | - Luca De Palma
- Division of Neurology, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Flavio Villani
- Clinical Epileptology and Experimental Neurophysiology Unit, Fondazione IRCCS, Istituto Neurologico C. Besta, Milan, Italy
| | | | | | - Nelia Zamponi
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi, University of Ancona, Ancona, Italy
| | - Gabriella Colicchio
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neuroscience, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| |
Collapse
|
5
|
Gilboa T, Segel R, Zeligson S, Alterescu G, Ben-Pazi H. Ganglioglioma, Epilepsy, and Intellectual Impairment due to Familial TSC1 Deletion. J Child Neurol 2018; 33:482-486. [PMID: 29687738 DOI: 10.1177/0883073818767036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a multisystem disorder diagnosed by clinical criteria and/or genetic testing. Genetic testing reveals atypical phenotypes that have not met clinical criteria, with practical implications. METHODS We describe 4 family members with pathogenic partial deletion in TSC1 who individually did not meet tuberous sclerosis complex clinical criteria. RESULTS Family members had different and atypical findings of tuberous sclerosis complex. Although none of the family members fulfilled the clinical criteria for tuberous sclerosis complex, they all carried the same genomic deletion (9q34.13q34.2) that included part of the TSC1 gene. One member had ganglioglioma and intractable seizures, one sibling presented with seizures, developmental delay, and displayed white matter abnormalities; another sibling had no clinical manifestations but has cortical tuber. Their mother has facial angiofibroma, cortical tuber, and seizures during infancy. CONCLUSIONS Ganglioglioma may be a phenotypic expression of TSC1. Genetic testing is recommended for infants with brain tumors, especially those with an abnormal familial history.
Collapse
Affiliation(s)
- Tal Gilboa
- 1 Neuropediatric Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Reeval Segel
- 2 Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sharon Zeligson
- 2 Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gheona Alterescu
- 2 Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hilla Ben-Pazi
- 3 Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Martinoni M, Marucci G, de Biase D, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Naldi I, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Tallini G, Giulioni M. BRAF V600E mutation in neocortical posterior temporal epileptogenic gangliogliomas. J Clin Neurosci 2015; 22:1250-3. [PMID: 25937573 DOI: 10.1016/j.jocn.2015.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/28/2015] [Accepted: 02/04/2015] [Indexed: 02/08/2023]
Abstract
The aim of this study was to verify the presence of BRAF mutations in a series of six patients affected by drug-resistant focal epilepsy associated with neocortical posterior temporal gangliogliomas (GG) who were subjected to lesionectomy between June 2008 and November 2013. GG are an increasingly recognized cause of epilepsy and represent the most common tumor in young patients undergoing surgery for intractable focal epilepsy. BRAF mutations have been identified in up to 50% of GG. Interestingly, these six patients shared a specific anatomical posterior temporal site. In all patients, histological examination confirmed the diagnosis of GG, and two were also associated with a focal cortical dysplasia (FCD) type IIa. BRAF mutations were found in four out of six GG (66.6%). Furthermore, dysplastic tissue of Patient 2 showed a concomitant BRAF V600E mutation. All patients but one (83.3%) achieved Engel Class Ia seizure control. The patient carrying a concomitant BRAF mutation in GG and FCD fell into Engel Class II. Further analyses will be required in order to better understand the meaning of BRAF mutations in epilepsy-associated tumors and FCD and their possible role as a prognostic seizure outcome and tumor behavior marker.
Collapse
Affiliation(s)
- Matteo Martinoni
- Division of Neurosurgery, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Via Altura 1/8, Bologna 40139, Italy.
| | - Gianluca Marucci
- Section of Pathology "M.Malpighi", Department of Biomedical and NeuroMotor Sciences, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Dario de Biase
- Department of Experimental, Diagnostic and Specialty Medicine, Anatomic Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Guido Rubboli
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Epilepsy Hospitalet, Dianalund, Denmark
| | - Lilia Volpi
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- Division of Neuroradiology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- Division of Neuroradiology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Ilaria Naldi
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Michelucci
- Division of Neurology, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Istituto delle scienze neurologiche di Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, Anatomic Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Marco Giulioni
- Division of Neurosurgery, IRCCS Istituto delle scienze neurologiche di Bologna, Bellaria Hospital, Via Altura 1/8, Bologna 40139, Italy
| |
Collapse
|
8
|
Crino PB. mTOR signaling in epilepsy: insights from malformations of cortical development. Cold Spring Harb Perspect Med 2015; 5:5/4/a022442. [PMID: 25833943 DOI: 10.1101/cshperspect.a022442] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Over the past decade enhanced activation of the mammalian target of rapamycin (mTOR)-signaling cascade has been identified in focal malformations of cortical development (MCD) subtypes, which have been collectively referred to as "mTORopathies." Mutations in mTOR regulatory genes (e.g., TSC1, TSC2, AKT3, DEPDC5) have been associated with several focal MCD highly associated with epilepsy such as tuberous sclerosis complex (TSC), hemimegalencephaly (HME; brain malformation associated with dramatic enlargement of one brain hemisphere), and cortical dysplasia. mTOR plays important roles in the regulation of cell division, growth, and survival, and, thus, aberrant activation of the cascade during cortical development can cause dramatic alterations in cell size, cortical lamination, and axon and dendrite outgrowth often observed in focal MCD. Although it is widely believed that structural alterations induced by hyperactivated mTOR signaling are critical for epileptogenesis, newer evidence suggests that mTOR activation on its own may enhance neuronal excitability. Clinical trials with mTOR inhibitors have shown efficacy in the treatment of seizures associated with focal MCD.
Collapse
Affiliation(s)
- Peter B Crino
- Shriners Hospital Pediatric Research Center and Department of Neurology, Temple University, Philadelphia, Pennsylvania 19140
| |
Collapse
|
9
|
Observations on epilepsy associated with low-grade tumors and focal cortical dysplasias. Childs Nerv Syst 2015; 31:507-9. [PMID: 25697146 DOI: 10.1007/s00381-015-2654-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 02/10/2015] [Indexed: 10/24/2022]
|
10
|
Martinoni M, Marucci G, Rubboli G, Volpi L, Riguzzi P, Marliani F, Toni F, Naldi I, Bisulli F, Tinuper P, Michelucci R, Baruzzi A, Giulioni M. Focal cortical dysplasias in temporal lobe epilepsy surgery: Challenge in defining unusual variants according to the last ILAE classification. Epilepsy Behav 2015; 45:212-6. [PMID: 25812941 DOI: 10.1016/j.yebeh.2015.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Focal cortical dysplasias (FCDs) represent a common architectural cortical disorder underlying pharmacoresistant focal epilepsy. The recent ILAE classification defines different types of FCDs based on their histopathological features, MRI imaging, and presumed pathogenesis; however, their clinical features and their prognostic significance are still incompletely defined. In addition, the combination of different histopathological abnormalities can represent "unusual" subtypes that can be difficult to classify. The aim of our study was to analyze the incidence and the significance of these "unusual" subtypes of FCDs in drug-resistant mesial temporal lobe epilepsy (MTLE). METHODS We retrospectively analyzed 133 patients consecutively submitted to tailored anteromesial temporal lobe resection for pharmacoresistant MTLE. Seizure onset, seizure duration, age at surgery, and postoperative seizure outcome were evaluated in relation to the different neuropathological groups defined according to the new ILAE classification. RESULTS Focal cortical dysplasias were found in 80 out of 133 patients. Six patients were affected by isolated FCD type I, 12 patients by FCD type II, and 44 patients by FCD type III. Furthermore, we found 18 "atypical" cases (20.5% of all FCD cases and 26.6% of FCDs associated with a principal lesion): 10 cases of associated FCD type II-hippocampal sclerosis (HS) and 8 cases associated with FCD II-epilepsy-associated tumors (EATs). CONCLUSION Our results indicate that "unusual" subtypes of FCDs, in particular associated FCD type II, are not uncommon findings, suggesting that they deserve a classification recognition. Similarities in seizure outcome and immunohistochemical and molecular evidences, shared by FCD type II+EATs and EATs, suggest a common pathogenic link. The choice to create a specific unifying class or, on the contrary, to also include "associated FCD type II" in the definition of the new unifying class FCD type III should be further discussed.
Collapse
Affiliation(s)
- Matteo Martinoni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy.
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology "M.Malpighi", Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Guido Rubboli
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy; Danish Epilepsy Centre, Dianalund, Denmark
| | - Lilia Volpi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Patrizia Riguzzi
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Federica Marliani
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Francesco Toni
- IRCCS Institute of Neurological Sciences of Bologna, Section of Neuroradiology, Bellaria Hospital, Bologna, Italy
| | - Ilaria Naldi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Francesca Bisulli
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Paolo Tinuper
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Michelucci
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurology, Bellaria Hospital, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Marco Giulioni
- IRCCS Institute of Neurological Science of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy
| |
Collapse
|
11
|
Giulioni M, Marucci G, Martinoni M, Marliani AF, Toni F, Bartiromo F, Volpi L, Riguzzi P, Bisulli F, Naldi I, Michelucci R, Baruzzi A, Tinuper P, Rubboli G. Epilepsy associated tumors: Review article. World J Clin Cases 2014; 2:623-641. [PMID: 25405186 PMCID: PMC4233414 DOI: 10.12998/wjcc.v2.i11.623] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/31/2014] [Accepted: 10/10/2014] [Indexed: 02/05/2023] Open
Abstract
Long-term epilepsy associated tumors (LEAT) represent a well known cause of focal epilepsies. Glioneuronal tumors are the most frequent histological type consisting of a mixture of glial and neuronal elements and most commonly arising in the temporal lobe. Cortical dysplasia or other neuronal migration abnormalities often coexist. Epilepsy associated with LEAT is generally poorly controlled by antiepileptic drugs while, on the other hand, it is high responsive to surgical treatment. However the best management strategy of tumor-related focal epilepsies remains controversial representing a contemporary issues in epilepsy surgery. Temporo-mesial LEAT have a widespread epileptic network with complex epileptogenic mechanisms. By using an epilepsy surgery oriented strategy LEAT may have an excellent seizure outcome therefore surgical treatment should be offered early, irrespective of pharmacoresistance, avoiding both the consequences of uncontrolled seizures as well as the side effects of prolonged pharmacological therapy and the rare risk of malignant transformation.
Collapse
|
12
|
Giulioni M, Martinoni M, Marucci G. Tailored pharmacoresistance related to underlying structural lesions. Epilepsy Behav 2014; 36:22-3. [PMID: 24840751 DOI: 10.1016/j.yebeh.2014.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/19/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Marco Giulioni
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology, Bellaria Hospital, Bologna, Italy.
| | - Matteo Martinoni
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology, Bellaria Hospital, Bologna, Italy
| | - Gianluca Marucci
- IRCCS Institute of Neurological Sciences of Bologna, Division of Neurosurgery, Bellaria Hospital, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Section of Pathology, Bellaria Hospital, Bologna, Italy
| |
Collapse
|
13
|
Erratum. APMIS 2013. [DOI: 10.1111/apm.12221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
14
|
Giulioni M, Marucci G, Martinoni M, Volpi L, Riguzzi P, Marliani AF, Bisulli F, Tinuper P, Tassinari CA, Michelucci R, Rubboli G. Seizure outcome in surgically treated drug-resistant mesial temporal lobe epilepsy based on the recent histopathological classifications. J Neurosurg 2013; 119:37-47. [PMID: 23641822 DOI: 10.3171/2013.3.jns122132] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT The study was performed to investigate the relation between seizure outcome after surgical treatment of mesial temporal lobe epilepsy (MTLE) and pathological findings, classified according to the recently proposed classifications of mesial temporal sclerosis (MTS), granule cell pathology (GCP), focal cortical dysplasia (FCD) and epilepsy-associated low-grade tumors (ELGT). METHODS The authors analyzed data obtained in 120 consecutive cases involving patients presenting with drug-resistant MTLE, who underwent tailored anteromesial temporal lobe resection, and correlated seizure outcome with pathological findings. They identified 5 histopathological groups: Group 1-ELGT, alone or associated with other lesions (30 cases); Group 2-isolated FCD (17 cases); Group 3-MTS, with or without GCP (28 cases); Group 4-MTS associated with FCD, with or without GCP (37 cases); Group 5-other lesions (8 cases). RESULTS Engel Class I outcome was observed in 83% of patients with ELGT (Class IA in 63%); in 59% of patients with isolated FCD, with FCD Type II showing a better prognosis than FCD Type I; in 82% of patients with isolated MTS (Class IA in 50%), with MTS Type 1a and MTS Type 1b showing a better prognosis than MTS Type 2 and patients with MTS and GCP having better postsurgical results than those with MTS without GCP. Engel Class I outcome was also achieved in 84% of patients with FCD associated with MTS (Engel Class IA in 62%); also in this group MTS 1a and MTS 1b associated with FCD showed a better prognosis than FCD associated with MTS 2. Finally, Engel Class I was also achieved in 2 patients with vascular malformation and in 1 with a temporal pole encephalocele. CONCLUSIONS Patients with MTLE and ELGT, MTS, or MTS associated with FCD showed the best postsurgical seizure outcome (Engel Class I in more than 80% of cases), whereas only 63% of patients with isolated FCD achieved the same type of outcome. Interestingly, the analysis of seizure outcome in histopathological subtypes of FCD and of MTS showed different prognoses in the different pathological subgroups, with worse outcomes for atypical MTS, absence of GCP, and isolated FCD Type I.
Collapse
Affiliation(s)
- Marco Giulioni
- Division of Neurosurgery, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|