The role of histopathologic subtype in the setting of hippocampal sclerosis–associated mesial temporal lobe epilepsy

Gales, Jordan; Jehi, Lara; Nowacki, Amy S.; Prayson, Richard A.

doi:10.1016/j.humpath.2017.02.013

Cited by 16 publications

(21 citation statements)

References 31 publications

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“…On the other hand, the effect of a remarkably shorter duration of epilepsy in the late-onset group on the absence of HS is unknown and open to interpretation. Similar to the recently reported analysis of ILAE classification-based HS subtypes and outcomes by our group, where 79% of 307 HS cases had associated FCD, 16 a large majority (60.7%) of current cohort also has similar findings.…”

Section: Discussionsupporting

confidence: 90%

Histopathologic substrate of drug‐resistant epilepsy in older adults and the elderly undergoing surgery

et al. 2019

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Summary Patients 60 years or older are one of the highest risk age groups for development of epilepsy. Clinical and neuroimaging analysis has typically accounted for etiology in two‐thirds of these patients, while the data on histopathology are lacking. We provide the first analysis of the histopathological substrates underlying drug‐resistant epilepsy (DRE) in older adults/elderly patients who underwent resective epilepsy surgery (RES) at Cleveland Clinic. A total of 78 patients (mean age ± standard deviation: 64.7 ± 3.7 years; 59% female) were included in the study. The most common pathologies included hippocampal sclerosis (HS; 35.9%; all visible on magnetic resonance imaging [MRI]), focal cortical dysplasia (FCD; 25.6%) and remote infarct/ischemic changes (12.8%). Underlying pathology did not differ significantly between the patients achieving a good seizure outcome (Engel class I; 77% [47 of 61 patients]) and the rest of the cohort. With one exception, all MRI‐negative cases had FCD type Ib. A receiver‐operating characteristic (ROC) curve analysis found a significant association ( P = 0.002) between seizure‐onset age and HS, whereby the odds of its presence were reduced by 4% for every 1 year increase in the age at seizure onset. The model showed that the age cutoff for seizure onset predicting HS was 43 years, with a negative predictive value of 81.6%. None of the 14 patients with late‐onset epilepsy (≥60 years of age) were found to have HS; they mostly had acquired lesions. Our study provides histopathologic evidence for the diminished role of late‐onset HS in DRE in older adults/elderly who undergo RES.

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Section: Discussionsupporting

confidence: 90%

Histopathologic substrate of drug‐resistant epilepsy in older adults and the elderly undergoing surgery

et al. 2019

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“…Engle’s class I outcomes were achieved in 40–75% of these FCD patients 12–14. Recently, several studies have analyzed the clinical characteristics and surgery outcomes of patients with the new FCD type III proposed by the ILAE 15–17. However, these studies compared specific FCD III subtypes with isolated epileptic lesions without FCD, and studies comparing the three FCD types are limited.…”

Section: Discussionmentioning

confidence: 99%

<p>Histological type of focal cortical dysplasia is associated with the risk of postsurgical seizure in children and adolescents</p>

Chen¹,

Huang²,

Li³

et al. 2019

TCRM

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Aim Focal cortical dysplasia (FCD) is a common cause of refractory epilepsy in children and adolescents. Epilepsy surgery is a treatment option for FCD. This study aimed to investigate the relationship between postsurgical outcomes and FCD types according to the International League Against Epilepsy (ILAE) classification and assess prognostic factors in pediatric and adolescent epilepsy surgery. Methods We retrospectively analyzed 92 children and adolescents with a proven pathological diagnosis of FCD who underwent resective surgery at our epilepsy center between August 2012 and September 2015. The patients were followed up for at least 1 year to evaluate the surgical outcomes, and a multivariable regression analysis was performed to identify risk factors of seizure relapse. Results After surgery, 53.3% of the patients were completely seizure-free during the entire follow-up period. The FCD types, incomplete resection of the epileptic cortex, and use of intracranial electrode were independent risk factors of seizure recurrence. The patients with FCD type II had relatively favorable surgical outcomes compared to the patients with FCD type I. The difference in the postoperative outcome between patients with FCD types III and I was not significant. Conclusion There is a significant association between FCD types and surgical outcomes in children and adolescents with epilepsy. These findings provide guidance for the optimization of surgical strategies.

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“…Inflammation is considered an important factor in the pathophysiology of seizures. All the risk factors for epilepsy such as traumas, tumors, and infections are accompanied by different degrees of inflammation in the central nervous system, which is associated with the occurrence of seizures [ 17 , 18 , 19 ]. However, little is known about the contribution of peripheral inflammation on the modulation of these events as well as on the relationship of the neuronal loss described in epilepsy with inflammatory processes.…”

Section: Introductionmentioning

confidence: 99%

Follow-Up of Peripheral IL-1β and IL-6 and Relation with Apoptotic Death in Drug-Resistant Temporal Lobe Epilepsy Patients Submitted to Surgery

Pedré

Chacón

Fuentes

et al. 2018

Behavioral Sciences

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Increasing amounts of evidence support the role of inflammation in epilepsy. This study was done to evaluate serum follow-up of IL-1β and IL-6 levels, as well as their concentration in the neocortex, and the relationship of central inflammation with NF-κB and annexin V in drug-resistant temporal lobe epileptic (DRTLE) patients submitted to surgical treatment. Peripheral and central levels of IL-1β and IL-6were measured by ELISA in 10 DRTLE patients. The sera from patients were taken before surgery, and 12 and 24 months after surgical treatment. The neocortical expression of NF-κB was evaluated by western blotting and annexin V co-localization with synaptophysin by immunohistochemistry. The neocortical tissues from five patients who died by non-neurological causes were used as control. Decreased serum levels of IL-1 and IL-6 were observed after surgery; at this time, 70% of patients were seizure-free. No values of IL-1 and IL-6 were detected in neocortical control tissue, whereas cytokine levels were evidenced in DRTLE. Increased NF-κB neocortex expression was found and the positive annexin V neurons were more obvious in the DRTLE tissue, correlating with IL-6 levels. The follow-up study confirmed that the inflammatory alterations disappeared one year after surgery, when the majority of patients were seizure-free, and the apoptotic death process correlated with inflammation.

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The role of histopathologic subtype in the setting of hippocampal sclerosis–associated mesial temporal lobe epilepsy

Cited by 16 publications

References 31 publications

Histopathologic substrate of drug‐resistant epilepsy in older adults and the elderly undergoing surgery

Histopathologic substrate of drug‐resistant epilepsy in older adults and the elderly undergoing surgery

<p>Histological type of focal cortical dysplasia is associated with the risk of postsurgical seizure in children and adolescents</p>

Follow-Up of Peripheral IL-1β and IL-6 and Relation with Apoptotic Death in Drug-Resistant Temporal Lobe Epilepsy Patients Submitted to Surgery

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