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 Printable version |
Temporal lobe epilepsy: neuropathological and clinical correlations in 243 surgically treated patients |
Epileptic Disorders. Volume 11, Number 4, 281-92, December 2009, Original article
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 Free Article
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Author(s) : Laura Tassi, Alessandra Meroni, Francesco Deleo, Flavio Villani, Roberto Mai, Giorgio Lo Russo, Nadia Colombo, Giuliano Avanzini, Chiara Falcone, Manuela Bramerio, Alberto Citterio, Rita Garbelli, Roberto Spreafico |
Summary : The present study included analysis of data from 243 patients surgically treated for Temporal Lobe Epilepsy (TLE). Resection was confined to the temporal lobe, with at least two years of follow-up, and specimens sufficiently preserved to allow a precise evaluation of both lateral neocortex and hippocampus. The frequency of different types of lesion and hippocampal sclerosis (HS), isolated or associated with neocortical lesions, risk factors and surgical outcomes in relation to neuropathological findings were evaluated. We found tumours in 33% of patients, malformations of cortical development (MCD) in 45%, isolated HS in 14%, no lesion in 5% and less common lesions in 3%. HS was present in 8% of tumour cases and 70% of MCD. Statistical analysis of antecedents was significantly associated only with febrile seizures (FS). In MCD patients with no history of FS, a strong association between HS and duration of epilepsy was revealed. A Class I outcome was identified in 87% of cases with tumours and 79% in cases with MCD. In 93 patients the antiepileptic drug therapy was withdrawn. Our findings show that MCD, which is significantly associated with HS, is the most common lesion in TLE and support the concept that an optimal outcome is obtained when mesial and neocortical structures are removed. FS are particularly relevant in patients with focal cortical dysplasia and HS. |
Keywords : AED, anti-epileptic drugs, DNT, dysembryoplastic neuroepithelial tumours, EEG, electroencephalogram, FS, febrile seizures, FCD, focal cortical dysplasia, FLAIR, fluid attenuated inversion-recovery, GFAP, glial fibrillary acid protein, HN, heterotopic neurons, HS, hippocampal sclerosis, IR, inversion recovery, MAP2, microtubule-associated protein-2, MCD, malformation of cortical development, MRI, magnetic resonance imaging, NeuN, neuron-specific nuclear protein, SE, spin-echo, SEEG, stereo-electroencephalography, TLE, temporal lobe epilepsy, TSE, turbo spin-echo, VEEG, video-electroencephalography |
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