A Retrospective Analysis of Hippocampal Pathology in Human Temporal Lobe Epilepsy: Evidence for Distinctive Patient Subcategories

Lanerolle, Nihal C. de; Kim, Jung Ho; Williamson, Anne; Spencer, Susan S.; Zaveri, Hitten P.; Eid, Tore; Spencer, Dennis D.

doi:10.1046/j.1528-1157.2003.00448.x

Cited by 90 publications

(161 citation statements)

References 15 publications

(20 reference statements)

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“…(17)(18)(19). In our Case 1 and that reported by Maki et al (16), the pathology was similar to hippocampal sclerosis without inflammatory changes, however the pathomechanism remains obscure.…”

Section: F I G U R E 5 P E R I V a S C U L A R L Y Mp H O C Y T I Csupporting

confidence: 80%

Neuropathological Studies of Patients with Possible Non-Herpetic Acute Limbic Encephalitis and So-called Acute Juvenile Female Non-Herpetic Encephalitis

et al. 2008

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Section: F I G U R E 5 P E R I V a S C U L A R L Y Mp H O C Y T I Csupporting

confidence: 80%

Neuropathological Studies of Patients with Possible Non-Herpetic Acute Limbic Encephalitis and So-called Acute Juvenile Female Non-Herpetic Encephalitis

et al. 2008

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“…Histopathological evaluation of the surgical specimens have also been suggested as a predictor of postoperative seizure control 6,7,15 . A favorable outcome has been related to a greater degree of hippocampal atrophy neuropathologically diagnosed as classical HS 7,13,16 .…”

Section: Discussionmentioning

confidence: 99%

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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“…9 Hippocampal excision surgery in this type of patient has a better surgical outcome than in those without sclerosis. Analysis of the pathology and electrophysiology of 151 hippocampi removed in the Yale surgical series revealed that after surgery, 84% of patients with sclerotic hippocampi had an excellent (Engel class I) outcome.…”

Section: Introductionmentioning

confidence: 88%

“…81 In the sclerotic hippocampus significant neuronal loss is reported in both the dentate gyrus and hippocampus proper (Ammon's horn). 9,82 Area CA1 neurons are the most susceptible to injury and was so noted more than a decade ago by Sommer. 83 The region is filled with reactive astrocytes, resulting in the hardening or sclerotic nature of the hippocampus.…”

Section: What Role Do Astrocytes Play In the Hippocampal Seizure Focus?mentioning

confidence: 95%

“…Analysis of the pathology and electrophysiology of 151 hippocampi removed in the Yale surgical series revealed that after surgery, 84% of patients with sclerotic hippocampi had an excellent (Engel class I) outcome. 9 In these sclerotic hippocampi, in addition to a greater than 50% loss of neurons, the glial density is increased by approximately 80% compared to nonsclerotic hippocampi and neurologically normal autopsy controls 10,11 (FIG. 1).…”

Section: Introductionmentioning

confidence: 99%

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Astrocytes and Epilepsy

2010

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Summary: Astrocytes form a significant constituent of seizure foci in the human brain. For a long time it was believed that astrocytes play a significant role in the causation of seizures. With the increase in our understanding of the unique biology of these cells, their precise role in seizure foci is receiving renewed attention. This article reviews the information now available on the role of astrocytes in the hippocampal seizure focus in patients with temporal lobe epilepsy with hippocampal sclerosis. Our intent is to try to integrate the available data. Astrocytes at seizure foci seem to not be a homogeneous population of cells, and in addition to typical glial fibrillary acidic protein, positive reactive astrocytes also include a population of neuron glia-2-like cells The astrocytes in sclerotic hippocampi differ from those in nonsclerotic hippocampi in their membrane physiology, having elevated Naϩ channels and reduced inwardly rectifying potassium ion channels, and some having the capacity to generate action potentials. They also have reduced glutamine synthetase and increased glutamate dehydrogenase activity. The molecular interface between the astrocyte and microvasculature is also changed. The astrocytes are also associated with increased expression of many molecules normally concerned with immune and inflammatory functions. A speculative mechanism postulates that neuron glia-2-like cells may be involved in creating a high glutamate environment, whereas the function of more typical reactive astrocytes contribute to maintain high extracellular Kϩ levels; both factors contributing to the hyperexcitability of subicular neurons to generate epileptiform activity. The functions of the astrocyte vascular interface may be more critical to the processes involved in epileptogenesis.

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A Retrospective Analysis of Hippocampal Pathology in Human Temporal Lobe Epilepsy: Evidence for Distinctive Patient Subcategories

Cited by 90 publications

References 15 publications

Neuropathological Studies of Patients with Possible Non-Herpetic Acute Limbic Encephalitis and So-called Acute Juvenile Female Non-Herpetic Encephalitis

Neuropathological Studies of Patients with Possible Non-Herpetic Acute Limbic Encephalitis and So-called Acute Juvenile Female Non-Herpetic Encephalitis

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

Astrocytes and Epilepsy

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