NEUROPATHOLOGICAL FINDINGS IN THE CZECH GROUP OF MESIAL TEMPORAL LOBE EPILEPSY PATIENTS: ETHIOPATHOGENETICAL IMPLICATIONS
Abstract number :
1.092
Submission category :
Year :
2003
Submission ID :
3813
Source :
www.aesnet.org
Presentation date :
12/6/2003 12:00:00 AM
Published date :
Dec 1, 2003, 06:00 AM
Authors :
Pavel Krsek, Josef Zamecnik, Michal Tichy, Petr Marusic, Vladimir Komarek Department of Paediatric Neurology, Charles University, 2nd Medical School, Prague, Czech Republic; Department of Pathology and Molecular Medicine, Charles University, 2nd Medical S
Hippocampal sclerosis represents a common structural basis of mesial temporal lobe epilepsy. However, the ethiopathogenetical mechanisms leading to its development remain unexplained. We present neuropathological findings in the resected hippocampus and the temporal pole in 17 patients with mesial temporal lobe epilepsy based on hippocampal sclerosis and correlate them with clinical data.
Patients were thoroughly examined using video EEG, MRI, MR spectroscopy, SPECT or FDG-PET and neuropsychological testing. All of them underwent anteromezial temporal lobectomy. Surgical specimens were analysed by routine neuropathological stainings as well as immunohistochemical techniques.
[quot]Initial precipitating injuries[quot] that are thought to cause the development of hippocampal sclerosis (febrile seizures in early childhood, head injury or meningoencephalitis) were present in the history of 13 of 17 patients. Attention was paid to the neuropathological identification of malformations of cortical development in the temporal lobe. These abnormalities were found in eight patients neuropathologically diagnosed as dual pathology cases. In seven of these cases, dual pathology was not identified by presurgical diagnostic tests. All four patients without initial precipitating injury in their history had the coincidence of hippocampal sclerosis with malformations of cortical development.
We suggest that in mesial temporal lobe epilepsy cases without predisposing history, hippocampal sclerosis arises due to undetected malformations of cortical development. However, a latent neocortical malformations may also contribute to the development of hippocampal sclerosis in patients with an initial precipitating injury. Neuropathological analysis of resected epileptic brain tissue can provide insight into individual pathogenesis of intractable epilepsy, especially by detection of microscopic cortical development abnormalities.
[Supported by: Grant GACR No. 309/02/D076, IGA NS 7411-3 and Research Projects No. 00000064203, 111300003 and 111300004.]