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Zhang X, Zhang J, Wang J, Zou D, Li Z. Analysis of forensic autopsy cases associated with epilepsy: Comparison between sudden unexpected death in epilepsy (SUDEP) and not-SUDEP groups. Front Neurol 2022; 13:1077624. [PMID: 36570468 PMCID: PMC9780386 DOI: 10.3389/fneur.2022.1077624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Background and aims Epilepsy is a common and chronic neurological disorder characterized by seizures that increase the risk of mortality. SUDEP is the most common seizure-related category of death. The study aimed to evaluate the key characteristics between SUDEP and not-SUDEP death cases. Methods A retrospective study of forensic autopsy cases from 2002 to 2021, performed by the Academy of Forensic Science (Ministry of Justice, China), identified a total of 31 deaths associated with epilepsy. We compared the different characteristics between individuals who died of SUDEP (SUDEP group) and individuals with epilepsy died suddenly due to unrelated causes (not-SUDEP group). Results and conclusions 13 cases met the general accepted definition of SUDEP; and 18 cases were classified as not-SUDEP. The mean age of the not-SUDEP group was significantly higher than that of the SUDEP groups (p < 0.05) and there were more cases without a clear cause of epilepsy in the SUDEP group than in the not-SUDEP group (p < 0.05). Death position differed significantly between the two groups, with more cases dying in the prone position in the SUDEP group (p < 0.05). Complete autopsies were performed in 24 of the 31 cases. There were no significant differences in heart, lungs and brain weights, or in ventricular thickness (p > 0.05) between the SUDEP and not-SUDEP groups. In addition, compared to the not-SUDEP group, the SUDEP group featured a significantly more cases with coronary lesions (grades 1-3, p < 0.05). Neuropathological lesions were identified in 12 of the 13 SUDEP cases (92.3%), cardiac lesions were present in 10 cases (76.9%) and pulmonary edema and pulmonary congestion were present in all cases. The primary cause of death in 13 of the 31 cases was seizure disorder or epilepsy. The primary mechanism of death in SUDEP group was mainly asphyxia while that in the not-SUDEP group was cardiopulmonary failure (p < 0.05). Patients in the prone position had a significantly higher risk of asphyxia than those who were not. Here, we investigated the key characteristics between SUDEP and not-SUDEP death cases, which may help to facilitate forensic diagnosis in presumed SUDEP cases.
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Affiliation(s)
- Xian Zhang
- Department of Cardiology, Kunshan Hospital of Integrated Traditional Chinese and Western Medicine, Jiangsu, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Ministry of Justice, Shanghai, China,*Correspondence: Jianhua Zhang
| | - Jinming Wang
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Ministry of Justice, Shanghai, China
| | - Donghua Zou
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Ministry of Justice, Shanghai, China,Donghua Zou
| | - Zhengdong Li
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Ministry of Justice, Shanghai, China,Zhengdong Li
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2
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Najm I, Lal D, Alonso Vanegas M, Cendes F, Lopes-Cendes I, Palmini A, Paglioli E, Sarnat HB, Walsh CA, Wiebe S, Aronica E, Baulac S, Coras R, Kobow K, Cross JH, Garbelli R, Holthausen H, Rössler K, Thom M, El-Osta A, Lee JH, Miyata H, Guerrini R, Piao YS, Zhou D, Blümcke I. The ILAE consensus classification of focal cortical dysplasia: An update proposed by an ad hoc task force of the ILAE diagnostic methods commission. Epilepsia 2022; 63:1899-1919. [PMID: 35706131 PMCID: PMC9545778 DOI: 10.1111/epi.17301] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/24/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
Ongoing challenges in diagnosing focal cortical dysplasia (FCD) mandate continuous research and consensus agreement to improve disease definition and classification. An International League Against Epilepsy (ILAE) Task Force (TF) reviewed the FCD classification of 2011 to identify existing gaps and provide a timely update. The following methodology was applied to achieve this goal: a survey of published literature indexed with ((Focal Cortical Dysplasia) AND (epilepsy)) between 01/01/2012 and 06/30/2021 (n = 1349) in PubMed identified the knowledge gained since 2012 and new developments in the field. An online survey consulted the ILAE community about the current use of the FCD classification scheme with 367 people answering. The TF performed an iterative clinico-pathological and genetic agreement study to objectively measure the diagnostic gap in blood/brain samples from 22 patients suspicious for FCD and submitted to epilepsy surgery. The literature confirmed new molecular-genetic characterizations involving the mechanistic Target Of Rapamycin (mTOR) pathway in FCD type II (FCDII), and SLC35A2 in mild malformations of cortical development (mMCDs) with oligodendroglial hyperplasia (MOGHE). The electro-clinical-imaging phenotypes and surgical outcomes were better defined and validated for FCDII. Little new information was acquired on clinical, histopathological, or genetic characteristics of FCD type I (FCDI) and FCD type III (FCDIII). The survey identified mMCDs, FCDI, and genetic characterization as fields for improvement in an updated classification. Our iterative clinico-pathological and genetic agreement study confirmed the importance of immunohistochemical staining, neuroimaging, and genetic tests to improve the diagnostic yield. The TF proposes to include mMCDs, MOGHE, and "no definite FCD on histopathology" as new categories in the updated FCD classification. The histopathological classification can be further augmented by advanced neuroimaging and genetic studies to comprehensively diagnose FCD subtypes; these different levels should then be integrated into a multi-layered diagnostic scheme. This update may help to foster multidisciplinary efforts toward a better understanding of FCD and the development of novel targeted treatment options.
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Affiliation(s)
- Imad Najm
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA
| | - Dennis Lal
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA.,Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Fernando Cendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil.,Department of Neurology, University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil
| | - Iscia Lopes-Cendes
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil.,Department of Translational Medicine, University of Campinas - UNICAMP, Campinas, Sao Paulo, Brazil
| | - Andre Palmini
- Department of Clinical Neurosciences, School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Porto Alegre Epilepsy Surgery Program, Hospital São Lucas PUCRS, Porto Alegre, Brazil
| | - Eliseu Paglioli
- Department of Surgery, School of Medicine, Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Harvey B Sarnat
- Department of Paediatrics, Department of Pathology (Neuropathology) and Department of Clinical Neurosciences, University of Calgary Faculty of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Christopher A Walsh
- Division of Genetics and Genomics and Howard Hughes Medical Institute, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Departments of Pediatrics and Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Stéphanie Baulac
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Roland Coras
- Department of Neuropathology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Katja Kobow
- Developmental Neurosciences Programme, UCL NIHR BRC Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J Helen Cross
- Developmental Neurosciences Programme, UCL NIHR BRC Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rita Garbelli
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Hans Holthausen
- Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen-Clinic, Vogtareuth, Germany
| | - Karl Rössler
- Department of Neurosurgery, Allgemeines Krankenhaus Wien, Vienna Medical University, Wien, Austria
| | - Maria Thom
- Department of Neuropathology, Institute of Neurology, University College London, UK
| | - Assam El-Osta
- Epigenetics in Human Health and Disease Laboratory, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeong Ho Lee
- Graduate School of Medical Science and Engineering, KAIST and SoVarGen, Daejeon, South Korea
| | - Hajime Miyata
- Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Anna Meyer- University of Florence, Florence, Italy
| | - Yue-Shan Piao
- National Center for Neurological Disorders, Department of Pathology, Xuanwu Hospital, Capital Medical University, and Clinical Research Center for Epilepsy, Capital Medical University, Beijing, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ingmar Blümcke
- Charles Shor Epilepsy Center, Neurological Institute, Cleveland, Ohio, USA.,Department of Neuropathology, Universitätsklinikum Erlangen, Erlangen, Germany
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Sóki N, Richter Z, Karádi K, Lőrincz K, Horváth R, Gyimesi C, Szekeres-Paraczky C, Horváth Z, Janszky J, Dóczi T, Seress L, Ábrahám H. Investigation of synapses in the cortical white matter in human temporal lobe epilepsy. Brain Res 2022; 1779:147787. [PMID: 35041843 DOI: 10.1016/j.brainres.2022.147787] [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: 09/16/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/02/2022]
Abstract
Temporal lobe epilepsy (TLE) is one of the most common focal pharmacotherapy-resistant epilepsy in adults. Previous studies have shown significantly higher numbers of neurons in the neocortical white matter in TLE patients than in controls. The aim of this work was to investigate whether white matter neurons are part of the neuronal circuitry. Therefore, we studied the distribution and density of synapses in surgically resected neocortical tissue of pharmacotherapy-resistant TLE patients. Neocortical white matter of temporal lobe from non-epileptic patients were used as controls. Synapses and neurons were visualized with immunohistochemistry using antibodies against synaptophysin and NeuN, respectively. The presence of synaptophysin in presynaptic terminals was verified by electron microscopy. Quantification of immunostaining was performed and the data of the patients' cognitive tests as well as clinical records were compared to the density of neurons and synapses. Synaptophysin density in the white matter of TLE patients was significantly higher than in controls. In TLE, a significant correlation was found between synaptophysin immunodensity and density of white matter neurons. Neuronal as well as synaptophysin density significantly correlated with scores of verbal memory of TLE patients. Neurosurgical outcome of TLE patients did not significantly correlate with histological data, although, higher neuronal and synaptophysin densities were observed in patients with favorable post-surgical outcome. Our results suggest that white matter neurons in TLE patients receive substantial synaptic input and indicate that white matter neurons may be integrated in epileptic neuronal networks responsible for the development or maintenance of seizures.
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Affiliation(s)
- Noémi Sóki
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary
| | - Zsófia Richter
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary
| | - Kázmér Karádi
- Department of Behavioral Sciences, University of Pécs Medical School Szigeti u. 12. Pécs, 7624, Hungary
| | - Katalin Lőrincz
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Réka Horváth
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Csilla Gyimesi
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - Cecília Szekeres-Paraczky
- Human Brain Research Laboratory, Institute of Experimental Medicine, ELKH Szigony u. 43. Budapest, 1083, Hungary
| | - Zsolt Horváth
- Department of Neurosurgery, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Center for Neuroscience, University of Pécs Ifjúság u 20. Pécs, 7624, Hungary
| | - Tamás Dóczi
- Department of Neurosurgery, University of Pécs Medical School Rét u. 2. Pécs, 7623, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Center for Neuroscience, University of Pécs Ifjúság u 20. Pécs, 7624, Hungary
| | - László Seress
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary
| | - Hajnalka Ábrahám
- Department of Medical Biology and Central Electron Microscopic Laboratory, University of Pécs Medical School Szigeti u. 12. Pécs, 7643, Hungary; Neuromorphology and Cellular Neurobiology Research Group, Center for Neuroscience, University of Pécs Ifjúság u. 20. Pécs, 7624, Hungary.
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White Matter Interstitial Neurons in the Adult Human Brain: 3% of Cortical Neurons in Quest for Recognition. Cells 2021; 10:cells10010190. [PMID: 33477896 PMCID: PMC7833373 DOI: 10.3390/cells10010190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 02/03/2023] Open
Abstract
White matter interstitial neurons (WMIN) are a subset of cortical neurons located in the subcortical white matter. Although they were fist described over 150 years ago, they are still largely unexplored and often considered a small, functionally insignificant neuronal population. WMIN are adult remnants of neurons located in the transient fetal subplate zone (SP). Following development, some of the SP neurons undergo apoptosis, and the remaining neurons are incorporated in the adult white matter as WMIN. In the adult human brain, WMIN are quite a large population of neurons comprising at least 3% of all cortical neurons (between 600 and 1100 million neurons). They include many of the morphological neuronal types that can be found in the overlying cerebral cortex. Furthermore, the phenotypic and molecular diversity of WMIN is similar to that of the overlying cortical neurons, expressing many glutamatergic and GABAergic biomarkers. WMIN are often considered a functionally unimportant subset of neurons. However, upon closer inspection of the scientific literature, it has been shown that WMIN are integrated in the cortical circuitry and that they exhibit diverse electrophysiological properties, send and receive axons from the cortex, and have active synaptic contacts. Based on these data, we are able to enumerate some of the potential WMIN roles, such as the control of the cerebral blood flow, sleep regulation, and the control of information flow through the cerebral cortex. Also, there is a number of studies indicating the involvement of WMIN in the pathophysiology of many brain disorders such as epilepsy, schizophrenia, Alzheimer’s disease, etc. All of these data indicate that WMIN are a large population with an important function in the adult brain. Further investigation of WMIN could provide us with novel data crucial for an improved elucidation of the pathophysiology of many brain disorders. In this review, we provide an overview of the current WMIN literature, with an emphasis on studies conducted on the human brain.
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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: 4] [Impact Index Per Article: 1.0] [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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6
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Lagarde S, Scholly J, Popa I, Valenti-Hirsch MP, Trebuchon A, McGonigal A, Milh M, Staack AM, Lannes B, Lhermitte B, Proust F, Benmekhbi M, Scavarda D, Carron R, Figarella-Branger D, Hirsch E, Bartolomei F. Can histologically normal epileptogenic zone share common electrophysiological phenotypes with focal cortical dysplasia? SEEG-based study in MRI-negative epileptic patients. J Neurol 2019; 266:1907-1918. [DOI: 10.1007/s00415-019-09339-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
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Thom M, Boldrini M, Bundock E, Sheppard MN, Devinsky O. Review: The past, present and future challenges in epilepsy-related and sudden deaths and biobanking. Neuropathol Appl Neurobiol 2019; 44:32-55. [PMID: 29178443 PMCID: PMC5820128 DOI: 10.1111/nan.12453] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Abstract
Awareness and research on epilepsy-related deaths (ERD), in particular Sudden Unexpected Death in Epilepsy (SUDEP), have exponentially increased over the last two decades. Most publications have focused on guidelines that inform clinicians dealing with these deaths, educating patients, potential risk factors and mechanisms. There is a relative paucity of information available for pathologists who conduct these autopsies regarding appropriate post mortem practice and investigations. As we move from recognizing SUDEP as the most common form of ERD toward in-depth investigations into its causes and prevention, health professionals involved with these autopsies and post mortem procedure must remain fully informed. Systematizing a more comprehensive and consistent practice of examining these cases will facilitate (i) more precise determination of cause of death, (ii) identification of SUDEP for improved epidemiological surveillance (the first step for an intervention study), and (iii) biobanking and cell-based research. This article reviews how pathologists and healthcare professionals have approached ERD, current practices, logistical problems and areas to improve and harmonize. The main neuropathology, cardiac and genetic findings in SUDEP are outlined, providing a framework for best practices, integration of clinical, pathological and molecular genetic investigations in SUDEP, and ultimately prevention.
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Affiliation(s)
- M Thom
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK
| | - M Boldrini
- Department of Psychiatry, Columbia University Medical Centre, Divisions of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - E Bundock
- Office of the Chief Medical Examiner, Burlington, VT, USA
| | - M N Sheppard
- Department of Pathology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - O Devinsky
- Department of Neurology, NYU Epilepsy Center, New York, NY, USA
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Liang J, Malherbe JAJ, Fuller KA, Mirzai B, George C, Carter TL, Cole CH, Guo BB, Meehan K, Erber WN. Automated enumeration of lymphoid and plasma cells in bone marrow to establish normal reference ranges. J Clin Pathol 2018; 71:916-925. [DOI: 10.1136/jclinpath-2018-205168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 01/16/2023]
Abstract
AimsThe number of precursor and mature lymphoid cells and plasma cells in normal bone marrow trephine (BMT) biopsies throughout the human lifespan is unknown. Reference ranges have been established from aspirated marrow, but due to haemodilution errors, these do not accurately reflect the native marrow milieu. We aimed to define age-specific, normal reference ranges for lymphoid and plasma cells in BMT biopsy specimens using a combined immunophenotyping and digital enumeration approach.MethodsMorphologically normal BMT biopsy specimens (n=483) were obtained from patients aged 1 month to 90 years of age. Immunohistochemistry was performed to identify lymphoid progenitors , T-lymphocytes (CD3), B-lymphocytes (CD20) and plasma cells (CD138 and MUM1). Positive cells were counted using digital enumeration software, and the percent positivity for each antigen was determined per case. Mean values were generated for specific age groups, and age-defined reference ranges were determined for each antigen using normalised data.ResultsA mean of 16 609 cells (range: 7210–34 097) were counted per biopsy. Infant marrows showed a predominance of immature lymphoid progenitors and B cells. With increasing age, an increase in mean T cell and plasma cell numbers were observed. The results showed the same trends to flow cytometry references for aspirate material although the absolute values differed.ConclusionsCombined immunohistochemistry and automated enumeration gives an accurate, reproducible number of antigen-positive cells and has generated normal reference ranges for these cell types in BMT biopsies. The method and ranges we have established have the potential to be applied in routine clinical practice.
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Liu J, Reeves C, Jacques T, McEvoy A, Miserocchi A, Thompson P, Sisodiya S, Thom M. Nestin-expressing cell types in the temporal lobe and hippocampus: Morphology, differentiation, and proliferative capacity. Glia 2018; 66:62-77. [PMID: 28925561 PMCID: PMC5724502 DOI: 10.1002/glia.23211] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/30/2017] [Accepted: 08/09/2017] [Indexed: 12/13/2022]
Abstract
Nestin is expressed in immature neuroepithelial and progenitor cell types and transiently upregulated in proliferative neuroglial cells responding to acute brain injury, including following seizures. In 36 temporal lobe (TLobe) specimens from patients with TLobe epilepsy (age range 8-60 years) we studied the number, distribution and morphology of nestin-expressing cells (NEC) in the pes, hippocampus body, parahippocampal gyrus, amygdala, temporal cortex and pole compared with post mortem control tissues from 26 cases (age range 12 gestational weeks to 76 years). The proliferative fraction of NEC was evaluated in selected regions, including recognized niches, using MCM2. Their differentiation was explored with neuronal (DCX, mushashi, βIII tubulin, NeuN) and glial (GFAP, GFAPdelta, glutamine synthetase, aquaporin4, EAAT1) markers, both in sections or following culture. Findings were correlated with clinical parameters. A stereotypical pattern in the distribution and morphologies of NEC was observed, reminiscent of patterns in the developing brain, with increased densities in epilepsy than adult controls (p < .001). Findings included MCM2-positive radial glial-like cells in the periventricular white matter and rows of NEC in the hippocampal fimbria and sulcus. Nestin cells represented 29% of the hippocampal proliferative fraction in epilepsy cases; 20% co-expressed βIII tubulin in culture compared with 28% with GFAP. Significant correlations were noted between age at surgery, memory deficits and nestin populations. TLobe NEC with ongoing proliferative capacity likely represent vestiges of developmental migratory streams and resident reactive cell populations of potential relevance to hippocampal epileptogenesis, TLobe pathology, and co-morbidities, including memory decline.
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Affiliation(s)
- Joan Liu
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, Queen SquareLondonWC1N 3BGUnited Kingdom
- Divisions of NeuropathologyNational Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUK
- Department of Biomedical SciencesUniversity of WestminsterLondonW1W 6UWUnited Kingdom
| | - Cheryl Reeves
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, Queen SquareLondonWC1N 3BGUnited Kingdom
- Divisions of NeuropathologyNational Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUK
| | - Thomas Jacques
- Department of NeuropathologyUCL Institute of Child Health and Great Ormond Street Hospital for ChildrenLondonUnited Kingdom
| | - Andrew McEvoy
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, Queen SquareLondonWC1N 3BGUnited Kingdom
- Neurosurgery at the National Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUnited Kingdom
| | - Anna Miserocchi
- Neurosurgery at the National Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUnited Kingdom
| | - Pamela Thompson
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, Queen SquareLondonWC1N 3BGUnited Kingdom
- The Chalfont Centre for Epilepsy, Chesham Lane, Chalfont St PeterBuckinghamshireSL9 0RJUnited Kingdom
- Department of NeuropsychologyNational Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUK
| | - Sanjay Sisodiya
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, Queen SquareLondonWC1N 3BGUnited Kingdom
- The Chalfont Centre for Epilepsy, Chesham Lane, Chalfont St PeterBuckinghamshireSL9 0RJUnited Kingdom
- Department of NeurologyNational Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUK
| | - Maria Thom
- Department of Clinical and Experimental EpilepsyUCL Institute of Neurology, Queen SquareLondonWC1N 3BGUnited Kingdom
- Divisions of NeuropathologyNational Hospital for Neurology and Neurosurgery, Queen SquareLondonWCN1BGUK
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Deleo F, Thom M, Concha L, Bernasconi A, Bernhardt BC, Bernasconi N. Histological and MRI markers of white matter damage in focal epilepsy. Epilepsy Res 2017; 140:29-38. [PMID: 29227798 DOI: 10.1016/j.eplepsyres.2017.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/10/2017] [Accepted: 11/20/2017] [Indexed: 12/21/2022]
Abstract
Growing evidence highlights the importance of white matter in the pathogenesis of focal epilepsy. Ex vivo and post-mortem studies show pathological changes in epileptic patients in white matter myelination, axonal integrity, and cellular composition. Diffusion-weighted MRI and its analytical extensions, particularly diffusion tensor imaging (DTI), have been the most widely used technique to image the white matter in vivo for the last two decades, and have shown microstructural alterations in multiple tracts both in the vicinity and at distance from the epileptogenic focus. These techniques have also shown promising ability to predict cognitive status and response to pharmacological or surgical treatments. More recently, the hypothesis that focal epilepsy may be more adequately described as a system-level disorder has motivated a shift towards the study of macroscale brain connectivity. This review will cover emerging findings contributing to our understanding of white matter alterations in focal epilepsy, studied by means of histological and ultrastructural analyses, diffusion MRI, and large-scale network analysis. Focus is put on temporal lobe epilepsy and focal cortical dysplasia. This topic was addressed in a special interest group on neuroimaging at the 70th annual meeting of the American Epilepsy Society, held in Houston December 2-6, 2016.
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Affiliation(s)
- Francesco Deleo
- NeuroImaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Canada
| | - Maria Thom
- Division of Neuropathology and Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Luis Concha
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, Mexico
| | - Andrea Bernasconi
- NeuroImaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Canada
| | - Boris C Bernhardt
- NeuroImaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Canada; Multimodal Imaging and Connectome Analysis Laboratory, Montreal Neurological Institute, McGill University, Canada
| | - Neda Bernasconi
- NeuroImaging of Epilepsy Laboratory, Montreal Neurological Institute, McGill University, Canada.
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11
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Thom M, Liu J, Bongaarts A, Reinten RJ, Paradiso B, Jäger HR, Reeves C, Somani A, An S, Marsdon D, McEvoy A, Miserocchi A, Thorne L, Newman F, Bucur S, Honavar M, Jacques T, Aronica E. Multinodular and vacuolating neuronal tumors in epilepsy: dysplasia or neoplasia? Brain Pathol 2017; 28:155-171. [PMID: 28833756 PMCID: PMC5887881 DOI: 10.1111/bpa.12555] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/27/2017] [Accepted: 08/01/2017] [Indexed: 12/28/2022] Open
Abstract
Multinodular and vacuolating neuronal tumor (MVNT) is a new pattern of neuronal tumour included in the recently revised WHO 2016 classification of tumors of the CNS. There are 15 reports in the literature to date. They are typically associated with late onset epilepsy and a neoplastic vs. malformative biology has been questioned. We present a series of ten cases and compare their pathological and genetic features to better characterized epilepsy‐associated malformations including focal cortical dysplasia type II (FCDII) and low‐grade epilepsy‐associated tumors (LEAT). Clinical and neuroradiology data were reviewed and a broad immunohistochemistry panel was applied to explore neuronal and glial differentiation, interneuronal populations, mTOR pathway activation and neurodegenerative changes. Next generation sequencing was performed for targeted multi‐gene analysis to identify mutations common to epilepsy lesions including FCDII and LEAT. All of the surgical cases in this series presented with seizures, and were located in the temporal lobe. There was a lack of any progressive changes on serial pre‐operative MRI and a mean age at surgery of 45 years. The vacuolated cells of the lesion expressed mature neuronal markers (neurofilament/SMI32, MAP2, synaptophysin). Prominent labelling of the lesional cells for developmentally regulated proteins (OTX1, TBR1, SOX2, MAP1b, CD34, GFAPδ) and oligodendroglial lineage markers (OLIG2, SMI94) was observed. No mutations were detected in the mTOR pathway genes, BRAF, FGFR1 or MYB. Clinical, pathological and genetic data could indicate that MVNT aligns more with a malformative lesion than a true neoplasm with origin from a progenitor neuro‐glial cell type showing aberrant maturation.
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Affiliation(s)
- Maria Thom
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK
| | - Joan Liu
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK
| | - Anika Bongaarts
- Department of (Neuro)Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Roy J Reinten
- Department of (Neuro)Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Beatrice Paradiso
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK.,Cardiovascular Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences University of Padua Medical School, Padova, Italy
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Cheryl Reeves
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK
| | - Alyma Somani
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK
| | - Shu An
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK
| | - Derek Marsdon
- Departments of Clinical and Experimental Epilepsy and Neuropathology, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, Queen Square, London WCN1BG, UK
| | - Andrew McEvoy
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Anna Miserocchi
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Lewis Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Fay Newman
- Neurosurgery Department, Brighton and Sussex University Hospitals, Brighton, UK
| | - Sorin Bucur
- Neurosurgery Department, Brighton and Sussex University Hospitals, Brighton, UK
| | - Mrinalini Honavar
- Department of Anatomic Pathology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Tom Jacques
- Neuropathology Department, Great Ormond Street Hospital, London, UK
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medical Center, Amsterdam, The Netherlands.,Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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12
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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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13
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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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14
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Mouton PR, Phoulady HA, Goldgof D, Hall LO, Gordon M, Morgan D. Unbiased estimation of cell number using the automatic optical fractionator. J Chem Neuroanat 2016; 80:A1-A8. [PMID: 27988177 DOI: 10.1016/j.jchemneu.2016.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/08/2016] [Accepted: 12/10/2016] [Indexed: 10/20/2022]
Abstract
A novel stereology approach, the automatic optical fractionator, is presented for obtaining unbiased and efficient estimates of the number of cells in tissue sections. Used in combination with existing segmentation algorithms and ordinary immunostaining methods, automatic estimates of cell number are obtainable from extended depth of field images built from three-dimensional volumes of tissue (disector stacks). The automatic optical fractionator is more accurate, 100% objective and 8-10 times faster than the manual optical fractionator. An example of the automatic fractionator is provided for counts of immunostained neurons in neocortex of a genetically modified mouse model of neurodegeneration. Evidence is presented for the often overlooked prerequisite that accurate counting by the optical fractionator requires a thin focal plane generated by a high optical resolution lens.
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Affiliation(s)
- Peter R Mouton
- Department of Pathology & Cell Biology, University of South Florida Colleges of Medicine and Engineering, 4001 E Fletcher Ave, Tampa, FL, 33613, USA; Byrd Alzheimer's Institute, University of South Florida College of Medicine, 4001 E Fletcher Ave, Tampa, FL, 33613, USA; Department of Computer Sciences and Engineering, College of Engineering, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Hady Ahmady Phoulady
- Department of Computer Sciences and Engineering, College of Engineering, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Dmitry Goldgof
- Department of Computer Sciences and Engineering, College of Engineering, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Lawrence O Hall
- Department of Computer Sciences and Engineering, College of Engineering, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, USA.
| | - Marcia Gordon
- Byrd Alzheimer's Institute, University of South Florida College of Medicine, 4001 E Fletcher Ave, Tampa, FL, 33613, USA.
| | - David Morgan
- Byrd Alzheimer's Institute, University of South Florida College of Medicine, 4001 E Fletcher Ave, Tampa, FL, 33613, USA.
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15
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Richter Z, Janszky J, Sétáló G, Horváth R, Horváth Z, Dóczi T, Seress L, Ábrahám H. Characterization of neurons in the cortical white matter in human temporal lobe epilepsy. Neuroscience 2016; 333:140-50. [DOI: 10.1016/j.neuroscience.2016.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/18/2016] [Accepted: 07/07/2016] [Indexed: 12/20/2022]
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16
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Mühlebner A, van Scheppingen J, Hulshof HM, Scholl T, Iyer AM, Anink JJ, van den Ouweland AMW, Nellist MD, Jansen FE, Spliet WGM, Krsek P, Benova B, Zamecnik J, Crino PB, Prayer D, Czech T, Wöhrer A, Rahimi J, Höftberger R, Hainfellner JA, Feucht M, Aronica E. Novel Histopathological Patterns in Cortical Tubers of Epilepsy Surgery Patients with Tuberous Sclerosis Complex. PLoS One 2016; 11:e0157396. [PMID: 27295297 PMCID: PMC4905625 DOI: 10.1371/journal.pone.0157396] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/27/2016] [Indexed: 11/19/2022] Open
Abstract
Tuberous Sclerosis Complex (TSC) is a genetic hamartoma syndrome frequently associated with severe intractable epilepsy. In some TSC patients epilepsy surgery is a promising treatment option provided that the epileptogenic zone can be precisely delineated. TSC brain lesions (cortical tubers) contain dysmorphic neurons, brightly eosinophilic giant cells and white matter alterations in various proportions. However, a histological classification system has not been established for tubers. Therefore, the aim of this study was to define distinct histological patterns within tubers based on semi-automated histological quantification and to find clinically significant correlations. In total, we studied 28 cortical tubers and seven samples of perituberal cortex from 28 TSC patients who had undergone epilepsy surgery. We assessed mammalian target of rapamycin complex 1 (mTORC1) activation, the numbers of giant cells, dysmorphic neurons, neurons, and oligodendrocytes, and calcification, gliosis, angiogenesis, inflammation, and myelin content. Three distinct histological profiles emerged based on the proportion of calcifications, dysmorphic neurons and giant cells designated types A, B, and C. In the latter two types we were able to subsequently associate them with specific features on presurgical MRI. Therefore, these histopathological patterns provide consistent criteria for improved definition of the clinico-pathological features of cortical tubers identified by MRI and provide a basis for further exploration of the functional and molecular features of cortical tubers in TSC.
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Affiliation(s)
- Angelika Mühlebner
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Hanna M. Hulshof
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Theresa Scholl
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Anand M. Iyer
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jasper J. Anink
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Mark D. Nellist
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Floor E. Jansen
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim G. M. Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pavel Krsek
- Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic
| | - Barbora Benova
- Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, Charles University, Second Medical School, Motol University Hospital, Prague, Czech Republic
| | - Peter B. Crino
- Shriners Hospital Pediatric Research Center and Department of Neurology, Temple University, Philadelphia, United States of America
| | - Daniela Prayer
- Department of Radiology, Medical University Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - Jasmin Rahimi
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | | | | | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Stichting voor Epilepsie in Nederland (SEIN), Hemstede, The Netherlands
- * E-mail:
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17
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Reeves C, Tachrount M, Thomas D, Michalak Z, Liu J, Ellis M, Diehl B, Miserocchi A, McEvoy AW, Eriksson S, Yousry T, Thom M. Combined Ex Vivo 9.4T MRI and Quantitative Histopathological Study in Normal and Pathological Neocortical Resections in Focal Epilepsy. Brain Pathol 2016; 26:319-33. [PMID: 26268959 PMCID: PMC4950048 DOI: 10.1111/bpa.12298] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/07/2015] [Indexed: 01/04/2023] Open
Abstract
High-resolution magnetic resonance imaging (MRI) may improve the preoperative diagnosis of focal cortical dysplasia (FCD) in epilepsy. Quantitative 9.4T MRI was carried out (T1, T2, T2* and magnetization transfer ratio) on 13 cortical resections, representing pathologically confirmed FCD (five cases) and normal cortex. Quantitative immunohistochemistry for myelination (myelin basic protein/SMI94), neuronal populations [microtubule-associated protein 2 (MAP2), neurofilament (SMI31, SMI32), synaptophysin, NeuN, calbindin], reactive glia (GFAP), microglia (CD68) and blood-brain barrier permeability (albumin) was carried out in 43 regions of interest (ROI) from normal and abnormal white matter and cortex. MRI was spatially aligned and quantitative analysis carried out on corresponding ROI. Line profile analysis (LPA) of intensity gradients through the cortex was carried out on MRI and immunostained sections. An inverse correlation was noted between myelin/SMI94 and T1, T2 (P < 0.005) and T2* (P < 0.05; Spearman's correlation) and a positive correlation between neuronal MAP2 and T1 (P < 0.005) and T2* (P < 0.05) over all ROI. Similar pathology-MRI correlations were observed for histologically unremarkable white matter ROI only. LPA showed altered gradient contours in regions of FCD, reflecting abnormal cortical lamination and myelo-architecture, including a preoperatively undetected FCD case. This study demonstrates the ability of quantitative 9.4T MRI to detect subtle differences in neuronal numbers and myelination in histologically normal appearing white matter and LPA in the evaluation of cortical dyslamination. These methods may be translatable to the in vivo detection of mild cortical malformations.
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Affiliation(s)
- Cheryl Reeves
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Mohamed Tachrount
- Department of NeuroradiologyUCL, Institute of NeurologyLondonUK
- Department of Brain Repair and RehabilitationUCL, Institute of NeurologyLondonUK
| | - David Thomas
- Department of Brain Repair and RehabilitationUCL, Institute of NeurologyLondonUK
| | - Zuzanna Michalak
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Joan Liu
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Matthew Ellis
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
| | - Beate Diehl
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Anna Miserocchi
- Department of NeurosurgeryUCL, Institute of NeurologyLondonUK
| | - Andrew W. McEvoy
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
- Department of NeurosurgeryUCL, Institute of NeurologyLondonUK
| | - Sofia Eriksson
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
| | - Tarek Yousry
- Department of NeuroradiologyUCL, Institute of NeurologyLondonUK
- Department of Brain Repair and RehabilitationUCL, Institute of NeurologyLondonUK
| | - Maria Thom
- Department of NeuropathologyUCL, Institute of NeurologyLondonUK
- Department of Clinical and Experimental EpilepsyUCL, Institute of NeurologyLondonUK
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18
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Mühlebner A, Iyer AM, van Scheppingen J, Anink JJ, Jansen FE, Veersema TJ, Braun KP, Spliet WGM, van Hecke W, Söylemezoğlu F, Feucht M, Krsek P, Zamecnik J, Bien CG, Polster T, Coras R, Blümcke I, Aronica E. Specific pattern of maturation and differentiation in the formation of cortical tubers in tuberous sclerosis omplex (TSC): evidence from layer-specific marker expression. J Neurodev Disord 2016; 8:9. [PMID: 27042238 PMCID: PMC4818922 DOI: 10.1186/s11689-016-9142-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/08/2016] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a multisystem disorder that results from mutations in the TSC1 or TSC2 genes, leading to constitutive activation of the mammalian target of rapamycin (mTOR) signaling pathway. Cortical tubers represent typical lesions of the central nervous system (CNS) in TSC. The pattern of cortical layering disruption observed in brain tissue of TSC patients is not yet fully understood, and little is known about the origin and phenotype of individual abnormal cell types recognized in tubers. METHODS In the present study, we aimed to characterize dysmorphic neurons (DNs) and giant cells (GCs) of cortical tubers using neocortical layer-specific markers (NeuN, SMI32, Tbr1, Satb2, Cux2, ER81, and RORβ) and to compare the features with the histo-morphologically similar focal cortical dysplasia (FCD) type IIb. We studied a cohort of nine surgically resected cortical tubers, five FCD type IIb, and four control samples using immunohistochemistry and in situ hybridization. RESULTS Cortical tuber displayed a prominent cell loss in all cortical layers. Moreover, we observed altered proportions of layer-specific markers within the dysplastic region. DNs, in both tubers and FCD type IIb, were found positive for different cortical layer markers, regardless of their laminar location, and their immunophenotype resembles that of cortical projection neurons. CONCLUSIONS These findings demonstrate that, similar to FCD type IIb, cortical layering is markedly disturbed in cortical tubers of TSC patients. Distribution of these disturbances is comparable in all tubers and suggests a dysmaturation affecting early and late migratory patterns, with a more severe impairment of the late stage of maturation.
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Affiliation(s)
- Angelika Mühlebner
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands ; Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Anand M Iyer
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Jasper J Anink
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Floor E Jansen
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tim J Veersema
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kees P Braun
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim van Hecke
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Figen Söylemezoğlu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Martha Feucht
- Department of Pediatrics, Medical University Vienna, Vienna, Austria
| | - Pavel Krsek
- Department of Neurology, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, Charles University, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic
| | | | - Tilman Polster
- Epilepsy Centre Bethel, Krankenhaus Mara, Bielefeld, Germany
| | - Roland Coras
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Academic Medical Center, Amsterdam, The Netherlands ; Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands ; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
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19
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Mortazavi F, Wang X, Rosene DL, Rockland KS. White Matter Neurons in Young Adult and Aged Rhesus Monkey. Front Neuroanat 2016; 10:15. [PMID: 26941613 PMCID: PMC4761867 DOI: 10.3389/fnana.2016.00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/05/2016] [Indexed: 01/21/2023] Open
Abstract
In humans and non-human primates (NHP), white matter neurons (WMNs) persist beyond early development. Their functional importance is largely unknown, but they have both corticothalamic and corticocortical connectivity and at least one subpopulation has been implicated in vascular regulation and sleep. Several other studies have reported that the density of WMNs in humans is altered in neuropathological or psychiatric conditions. The present investigation evaluates and compares the density of superficial and deep WMNs in frontal (FR), temporal (TE), and parietal (Par) association regions of four young adult and four aged male rhesus monkeys. A major aim was to determine whether there was age-related neuronal loss, as might be expected given the substantial age-related changes known to occur in the surrounding white matter environment. Neurons were visualized by immunocytochemistry for Neu-N in coronal tissue sections (30 μm thickness), and neuronal density was assessed by systematic random sampling. Per 0.16 mm2 sampling box, this yielded about 40 neurons in the superficial WM and 10 in the deep WM. Consistent with multiple studies of cell density in the cortical gray matter of normal brains, neither the superficial nor deep WM populations showed statistically significant age-related neuronal loss, although we observed a moderate decrease with age for the deep WMNs in the frontal region. Morphometric analyses, in contrast, showed significant age effects in soma size and circularity. In specific, superficial WMNs were larger in FR and Par WM regions of the young monkeys; but in the TE, these were larger in the older monkeys. An age effect was also observed for soma circularity: superficial WMNs were more circular in FR and Par of the older monkeys. This second, morphometric result raises the question of whether other age-related morphological, connectivity, or molecular changes occur in the WMNs. These could have multiple impacts, given the wide range of putative WMN functions and their involvement in both corticothalamic and corticocortical circuitry.
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Affiliation(s)
- Farzad Mortazavi
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston, MA, USA
| | - Xiyue Wang
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston, MA, USA
| | - Douglas L Rosene
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston, MA, USA
| | - Kathleen S Rockland
- Department of Anatomy and Neurobiology, Boston University School of Medicine Boston, MA, USA
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20
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Dunn WD, Gearing M, Park Y, Zhang L, Hanfelt J, Glass JD, Gutman DA. Applicability of digital analysis and imaging technology in neuropathology assessment. Neuropathology 2015; 36:270-82. [PMID: 26577803 DOI: 10.1111/neup.12273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 01/27/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurological disorder that affects more than 30 million people worldwide. While various dementia-related losses in cognitive functioning are its hallmark clinical symptoms, ultimate diagnosis is based on manual neuropathological assessments using various schemas, including Braak staging, CERAD (Consortium to Establish a Registry for Alzheimer's Disease) and Thal phase scoring. Since these scoring systems are based on subjective assessment, there is inevitably some degree of variation between readers, which could affect ultimate neuropathology diagnosis. Here, we report a pilot study investigating the applicability of computer-driven image analysis for characterizing neuropathological features, as well as its potential to supplement or even replace manually derived ratings commonly performed in medical settings. In this work, we quantitatively measured amyloid beta (Aβ) plaque in various brain regions from 34 patients using a robust digital quantification algorithm. We next verified these digitally derived measures to the manually derived pathology ratings using correlation and ordinal logistic regression methods, while also investigating the association with other AD-related neuropathology scoring schema commonly used at autopsy, such as Braak and CERAD. In addition to successfully verifying our digital measurements of Aβ plaques with respective categorical measurements, we found significant correlations with most AD-related scoring schemas. Our results demonstrate the potential for digital analysis to be adapted to more complex staining procedures commonly used in neuropathological diagnosis. As the efficiency of scanning and digital analysis of histology images increases, we believe that the basis of our semi-automatic approach may better standardize quantification of neuropathological changes and AD diagnosis, ultimately leading to a more comprehensive understanding of neurological disorders and more efficient patient care.
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Affiliation(s)
- William D Dunn
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marla Gearing
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yuna Park
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lifan Zhang
- Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John Hanfelt
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jonathan D Glass
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A Gutman
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
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21
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Dalen Meurs-van der Schoor C, van Weissenbruch M, van Kempen M, Bugiani M, Aronica E, Ronner H, Vermeulen RJ. Severe Neonatal Epileptic Encephalopathy and KCNQ2 Mutation: Neuropathological Substrate? Front Pediatr 2014; 2:136. [PMID: 25566516 PMCID: PMC4271583 DOI: 10.3389/fped.2014.00136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/17/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neonatal convulsions are clinical manifestations in a heterogeneous group of disorders with different etiology and outcome. They are attributed to several genetic causes. METHODS We describe a patient with intractable neonatal seizures who died from respiratory compromise during a status epilepticus. RESULTS This case report provides electroencephalogram (EEG), MRI, genetic analysis, and neuropathological data. Genetic analysis revealed a de novo heterozygous missense mutation in the KCNQ2 gene, which encodes a subunit of a voltage-gated potassium channel. KCNQ2 gene mutation is associated with intractable neonatal seizures. EEG, MRI, data as well as mutation analysis have been described in other KCNQ2 cases. Post-mortem neuropathological investigation revealed mild malformation of cortical development with increased heterotopic neurons in the deep white matter compared to an age-matched control subject. The new finding of this study is the combination of a KCNQ2 mutation and the cortical abnormalities. CONCLUSION KCNQ2 mutations should be considered in neonates with refractory epilepsy of unknown cause. The mild cortical malformation is an important new finding, though it remains unknown whether these cortical abnormalities are due to the KCNQ2 mutation or are secondary to the refractory seizures.
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Affiliation(s)
| | | | - Marjan van Kempen
- Department of Medical Genetics, University Medical Center , Utrecht , Netherlands
| | - Marianna Bugiani
- Department of Pathology, Neuroscience Campus Amsterdam, VU University Medical Center , Amsterdam , Netherlands ; Department of Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Center , Amsterdam , Netherlands
| | - Eleonora Aronica
- Department of Pathology, Academic Medical Center , Amsterdam , Netherlands
| | - Hanneke Ronner
- Department of Clinical Neurophysiology, VU University Medical Center , Amsterdam , Netherlands
| | - R Jeroen Vermeulen
- Department of Child Neurology, Neuroscience Campus Amsterdam, VU University Medical Center , Amsterdam , Netherlands
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