A grading system for mesial temporal pathology (hippocampal sclerosis) from anterior temporal lobectomy

Wyler, Allen R.; Dohan, F. C.; Schweitzer, John B.; Berry, Allen D.

doi:10.1016/s0896-6974(05)80120-3

Cited by 199 publications

(128 citation statements)

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“…Despite electrophysiological evidence for TLE, three surgical specimens did not present specific neuronal cell loss. This finding has been reported in similar surveys 1,6,7,15,18 and no long has been explained.…”

Section: Discussionsupporting

confidence: 85%

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

Jardim

Neves

Caboclo

et al. 2012

Arq. Neuro-Psiquiatr.

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Article temporal lobe epilepsy with mesial temporal sclerosis: hippocampal neuronal loss as a predictor of surgical outcome Epilepsia do lobo temporal com esclerose mesial temporal: o padrão da perda neuronal hipocampal como preditor do prognóstico cirúrgico Anaclara Prada Jardim¹, Rafael Scarpa da Costa Neves¹, Luís Otávio Sales Ferreira Caboclo¹, Carmen Lucia Penteado Lancellotti² , ³, Murilo Martinez Marinho¹, Ricardo Silva Centeno¹, Esper Abrão Cavalheiro 4 , Carla Alessandra Scorza 4 , Elza Márcia Targas Yacubian¹Mesial temporal sclerosis (MTS) is the most common pathological finding in drug refractory, chronic temporal lobe epilepsy (TLE) 1 . Mesial temporal lobe structures with a sclerotic hippocampus have been considered the site of seizure onset for most TLE patients, and hippocampal sclerosis (HS) has been considered essential for MTS diagnosis. Surgery has become the treatment of choice in the management of patients with this epilepsy syndrome 2,3 . Tailored resections of temporal neocortex and mesial temporal structures, including hippocampus and amygdala, are an established epilepsy treatment modality and offer a favorable outcome in approximately two-thirds of patients 4,5 .The reason why around one-third of individuals with this epilepsy syndrome still present seizures after surgical treatment ABStrActObjective: To analyze retrospectively a series of patients with temporal lobe epilepsy (TLE) and mesial temporal sclerosis (MTS), and the association of patterns of hippocampal sclerosis with clinical data and surgical prognosis. Method: Sixty-six patients with medically refractory TLE with unilateral MTS after anterior temporal lobectomy were included. Quantitative neuropathological evaluation was performed on NeuN-stained hippocampal sections. Patient's clinical data and surgical outcome were reviewed. Results: Occurrence of initial precipitating insult (IPI), as well as better postoperative seizure control (i.e. Engel class 1), were associated with classical and severe patterns of hippocampal sclerosis (MTS type 1a and 1b, respectively). Conclusion: Quantitative evaluation of hippocampal neuronal loss patterns predicts surgical outcome in patients with TLE-MTS.Key words: epilepsy, temporal lobe, mesial temporal sclerosis, hippocampal sclerosis, pathology, surgical prognosis. reSUMO Objetivo: Analisar retrospectivamente uma série de pacientes com epilepsia do lobo temporal (ELT) e esclerose mesial temporal (EMT), bem como correlacionar os padrões de esclerose hipocampal com os dados clínicos e o prognóstico cirúrgico. Métodos: Foram incluídos neste estudo 66 pacientes com ELT refratária a tratamento medicamentoso e com EMT unilateral submetidos à lobectomia temporal anterior. A análise neuropatológica quantitativa foi realizada em seções hipocampais imunomarcadas com NeuN. Dados clínicos e resultados do acompanhamento pós-cirúrgico foram revisados. Resultados: Ocorrência de evento precipitante inicial e melhor controle de crises após a cirurgia (i.e. classe 1 de Engel) foram associados aos pad...

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Section: Discussionsupporting

confidence: 85%

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

Jardim

Neves

Caboclo

et al. 2012

Arq. Neuro-Psiquiatr.

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“…A significant decrease of VGLUT1 protein was described in subfields with neuronal loss and a significant increase in the DG, marked by mossy fiber sprouting [33]. In our hippocampal homogenates from patients, diagnosed and classified as the classical form, Wyler grade 3 [17,37], the unaltered hippocampal VGLUT1 protein expression could be the result of increased VGLUT1 expression in the DG that compensates the more moderate loss of VGLUT1 in other hippocampal subregions.…”

Section: Discussionmentioning

confidence: 58%

“…Possibly, this discrepancy results from a slight difference in severity of HS together with the fact that, we have used total hippocampus. Although the so-called classical and severe cell loss patterns in HS [32], are now internationally classified as HS ILAE type1 [3], the hippocampal sclerotic tissue used by Wyler et al was, at that time, diagnosed and classified as the most severe form, Wyler grade 4 [37]. A significant decrease of VGLUT1 protein was described in subfields with neuronal loss and a significant increase in the DG, marked by mossy fiber sprouting [33].…”

Section: Discussionmentioning

confidence: 99%

Altered vesicular glutamate transporter expression in human temporal lobe epilepsy with hippocampal sclerosis

Liefferinge

Jensen

Albertini

et al. 2015

Neuroscience Letters

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Link to publication Citation for published version (APA):Van Liefferinge, J., Jensen, C. J., Albertini, G., Bentea, E., Demuyser, T., Merckx, E., ... Massie, A. (2015). Altered vesicular glutamate transporter expression in human temporal lobe epilepsy with hippocampal sclerosis. Neuroscience Letters, 590, 184-188. DOI: 10.1016/j.neulet.2015 General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 13 May 2018Neuroscience Letters 590 (2015) [184][185][186][187][188] Contents lists available at ScienceDirect Neuroscience Letters j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / n e u l e t h i g h l i g h t s• VGLUTs mRNA remains unaffected in human sclerotic hippocampus ILAE type1.• Unaltered total VGLUT1 protein level in hippocampus of human TLE with HS ILAE type1.• Decreased VGLUT2 protein expression in hippocampus of human TLE with HS ILAE type1.• Increased VGLUT3 protein expression in hippocampus of human TLE with HS ILAE type1. a b s t r a c t Vesicular glutamate transporters (VGLUTs) are responsible for loading glutamate into synaptic vesicles. Altered VGLUT protein expression has been suggested to affect quantal size and glutamate release under both physiological and pathological conditions. In this study, we investigated mRNA and protein expression levels of the three VGLUT subtypes in hippocampal tissue of patients suffering from temporal lobe epilepsy (TLE) with hippocampal sclerosis (HS), International League Against Epilepsy type1 (ILAE type1) compared to autopsy controls, using quantitative polymerase chain reaction and semi-quantitative western blotting. mRNA expression levels of the VGLUTs are unaffected in hippocampal epileptic tissue compared to autopsy controls. At the protein level, VGLUT1 expression remains unaltered, while VGLUT2 is significantly decreased and VGLUT3 protein is significantly increased in hippocampal biopsies from TLE patients compared to controls. Our findings at the protein level can be explained by previously described histopathological changes observed in HS. a r t i c l e i n f oAlthough VGLUTs have been repeatedly investigated in distinct rodent epilepsy models, their expression levels were hitherto not fully unraveled in the most difficult-to-treat form of epilepsy: TLE with HS ILAE t...

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“…After reviewing the entire hippocampal specimen, we used the sections showing the most severe involvement to grade pathology. Details regarding the development and refinement of the grading system were reported in greater detail previously (37). Neuronal cell counts were not performed, but assessment of the degree of neuronal loss was based on a comparison with a standard.…”

Section: Hippocampal Grading Systemmentioning

confidence: 99%

Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus

et al. 1998

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Summary: Purpose:To evaluate the determinants of postoperative change in visual confrontation naming ability and the differential sensitivity of two common tests of confrontation naming.Methods: In a group of 99 patients undergoing lobectomy of the left, language-dominant anterior temporal lobe, we examined naming ability using two measures: the 60 item Boston Naming Test (BNT), and the Visual Naming (VN) subtest of the Multilingual Aphasia Examination (MAE). ATL entailed resection of lateral temporal lobe followed by microsurgical complete removal of hippocampus. Language mapping was not performed. The status of the resected hippocampus was graded on a scale 0-4 of hippocampal sclerosis (HS). A dichotomous grouping HS-(grades 0 and 1, n = 34) and HS+ (grades 3 and 4, n = 61) was effected. Age at surgery, age of epilepsy onset, sex, extent of lateral temporal resection, Full-Scale IQ (FSIQ), and preoperative naming scores were also examined as potential predictors of pre-versus postoperative naming change.Results: Preoperative BNT and VN scores were significantly worse for HS+ than for HS-(BNT, p c 0.05; VN, p = 0.001).Postoperatively, BNT and VN scores significantly declined for HS-as compared with HS+ patients (p c 0.001). For individual risk, the 90th centile of reliable change index (RCI) was used. By this criterion, of the total sample, 39% evidenced decline on the BNT and 17% evidenced decline on the VN. Logistic regression analysis with backward elimination showed HS to be the only predictor of decline in BNT and HS and sex to be the only predictors of VN decline. Males were more at risk than females. Age, age at onset, extent of lateral resection, preoperative scores, and FSIQ were not predictors. Using age at onset as a proxy for HS+/HS-we calculated probabilities for naming decline for given onset age. Conclusions: Both preoperative and postoperative change in naming ability are associated with the pathological status of the hippocampus. The potential interpretations and implications of these findings are discussed.

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A grading system for mesial temporal pathology (hippocampal sclerosis) from anterior temporal lobectomy

Cited by 199 publications

References 2 publications

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

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

Altered vesicular glutamate transporter expression in human temporal lobe epilepsy with hippocampal sclerosis

Naming Decline After Left Anterior Temporal Lobectomy Correlates with Pathological Status of Resected Hippocampus

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