Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Jardim, Anaclara Prada; Neves, Rafael Scarpa da Costa; Caboclo, Luís Otávio Sales Ferreira; Lancellotti, Carmen Lúcia Penteado; Marinho, Murilo Martinez; Centeno, Ricardo Silva; Cavalheiro, Ésper A.; Scorza, Carla A.; Yacubian, Elza Márcia Targas

doi:10.1590/s0004-282x2012000500003

Cited by 31 publications

(32 citation statements)

References 23 publications

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“…The distribution of HS types (74% type 1, 25% type 2, and only one patient with type 3) is slightly different from that reported in some studies, 12,14,15,22 but similar to the recent findings of Savitr Sastri et al, 25 and confirms that type 1 is the most frequent, whereas CA4-predominant type 3 is rare, accounting for no more than approximately 4% of the patients in some cohorts, 4,14,15 and none at all in others. 12,22 Only one recent study 36 has reported a very high incidence of type 3 HS (24%), possibly because of a difference in the selection of patients for epilepsy surgery, as it has been reported that CA4-predominant sclerosis is frequently associated with another principal pathology. 37 The proportions of HS types 1 and 2 were maintained when the patients were divided into the neuropathologic subgroups of IHS, FCD III, and DP, thus indicating that they are independent of associated pathologies; however, when the patients with DP were further subdivided, type 2 clearly prevailed in patients with tumors, and type 1 was almost always associated with other principal lesions.…”

Section: (4-12)supporting

confidence: 68%

“…26 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) 36 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) 85 (91) 62 (67) Type 1 70 (74) 33 (47) 38 (54) 27 (39) 13 (19) 6 (3-10) (25) 7 (30) 11 (48) 5 (22) 7 ( 42 (43) 58 (60) 22 (23) 19 (20) 8 (4-13)…”

Section: (4-15)unclassified

“…26 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) 38 (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43) 61 (85) 49 (68) Type 2 24 (25) 8 (33) 16 (67) 7 (29) 6 (25) 7 ( 44-45% of the selected population, but only 11% were affected by DP. The distribution of HS types (74% type 1, 25% type 2, and only one patient with type 3) is slightly different from that reported in some studies, 12,14,15,22 but similar to the recent findings of Savitr Sastri et al, 25 and confirms that type 1 is the most frequent, whereas CA4-predominant type 3 is rare, accounting for no more than approximately 4% of the patients in some cohorts, 4,14,15 and none at all in others.…”

Section: (4-12)mentioning

confidence: 99%

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Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

et al. 2015

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SUMMARYObjective: Hippocampal sclerosis (HS) is the most frequent neuropathologic finding in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). The International League Against Epilepsy (ILAE) has recently proposed a new classification of HS based on specific patterns of cell loss. The aim of this study was to investigate the relationships between HS types, their etiologic factors, and the short-and long-term postsurgical outcomes of patients undergoing surgery because of drug-resistant TLE with HS. Methods: Two hundred thirteen patients with a neuropathologic diagnosis of HS and a minimum follow-up of 2 years were divided on the basis of their ILAE HS type and further classified into: (1) isolated HS, (2) HS associated with focal cortical dysplasia (FCD IIIa), or (3) HS associated with other lesions. Their clinical and neuropathologic data were correlated with their Engel class postsurgical outcomes. Results: The main findings were the following: (1) HS type 1 was associated with a longer duration of epilepsy; (2) >80% of the patients had an Engel class I short-and long-term outcomes, regardless of HS type and associated pathology; (3) short-and long-term postsurgical outcomes were less satisfactory in the patients who were completely seizure-free (Engel class Ia), and patients with HS type 2 had better long-term seizure outcomes than those with type 1; (4) the concomitant presence of FCD contributed to a worse outcome, regardless of HS type; and (5) a shorter duration of epilepsy significantly correlated with an Engel class Ia outcome. Significance: These data suggest that HS type and associated pathologies may predict the risk of recurrence, but other variables such as the duration of epilepsy need to be considered. A common neuropathologic classification system may help to identify preoperative predictive factors and improve the selection of patients who may benefit from epilepsy surgery.

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Section: (4-12)supporting

confidence: 68%

Section: (4-15)unclassified

Section: (4-12)mentioning

confidence: 99%

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Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

et al. 2015

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“…Postsurgical prognosis was worse in patients with CA 1 predominant neuronal loss, as in those without signs of MTS. Jardim et al 34 studied 66 TLE with MTS patients, analyzing clinical characteristics and MTS patterns. Occurrence of initial precipitating insult, as well as better postoperative seizure control, was associated with classical (type 1a) and severe (type 1b) patterns of MTS.…”

Section: Temporal Lobe Epilepsy: Surgical Pathologymentioning

confidence: 99%

Surgical and postmortem pathology studies: contribution for the investigation of temporal lobe epilepsy

Caboclo

Neves

Jardim

et al. 2012

Arq. Neuro-Psiquiatr.

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Pathology studies in epilepsy patients bring useful information for comprehending the physiopathology of various forms of epilepsy, as well as aspects related to response to treatment and long-term prognosis. These studies are usually restricted to surgical specimens obtained from patients with refractory focal epilepsies. Therefore, most of them pertain to temporal lobe epilepsy (TLE) with mesial temporal sclerosis (MTS) and malformations of cortical development (MCD), thus providing information of a selected group of patients and restricted regions of the brain. Postmortem whole brain studies are rarely performed in epilepsy patients, however they may provide extensive information on brain pathology, allowing the analysis of areas beyond the putative epileptogenic zone. In this article, we reviewed pathology studies performed in epilepsy patients with emphasis on neuropathological findings in TLE with MTS and MCD. Furthermore, we reviewed data from postmortem studies and discussed the importance of performing these studies in epilepsy populations.

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“…Surgery is suggested for nonresponsive cases to reduce recurrence of seizures (2).Surgery in patients with refractory TLE by antiepileptic drugs (AEDs) is invasive, expensive, and carries a surgical risk; however, one-third of the patients develop seizural activity following surgery (3).…”

Section: Introductionmentioning

confidence: 99%

Follow-up Case Report: Bumetanide Can Control Seizural Activity in Temporal Lobe Epilepsy Patient

et al. 2017

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Despite the infectiveness of conventional anti-epileptic drugs (AEDs) in refractory focal epilepsy, surgery along with medications, as the only treatment, was not successful in 30% of the cases. Recently, cysto-and histo-physiological investigations revealed the role of gamma-aminobutyric acid (GABA)-ergic system in etiopathology of temporal lobe epilepsy (TLE). Studies reported that the inhibitory action of GABA neurotransmitter due to elevated intracellular Cl-concentration through abnormal expression of Na-K-Cl cotransporter (NKCC)-1 became excessive in recurrent seizures. These primary results were confirmed in the brain tissue obtained from patients with TLE. Based on the evidence, the current study suggested the administration of bumetanide, an NKCC1 inhibitor, as a potential candidate for the treatment of intractable TLE. The previous study by authors showed a significant reduction in seizural activity of 2 out of 3 patients with TLE following the administration of bumetanide. However, result of the current study showed the control of seizure in the 3rd case of previous study by the administration of bumetanide as an adjuvant to AEDs. Moreover, his AEDs dosage after discontinuation of Bumetanide tapered without any relapse.

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Temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome

Cited by 31 publications

References 23 publications

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

Short‐ and long‐term surgical outcomes of temporal lobe epilepsy associated with hippocampal sclerosis: Relationships with neuropathology

Surgical and postmortem pathology studies: contribution for the investigation of temporal lobe epilepsy

Follow-up Case Report: Bumetanide Can Control Seizural Activity in Temporal Lobe Epilepsy Patient

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