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Priya, Yadav N, Anand S, Banerjee J, Tripathi M, Chandra PS, Dixit AB. The multifaceted role of Wnt canonical signalling in neurogenesis, neuroinflammation, and hyperexcitability in mesial temporal lobe epilepsy. Neuropharmacology 2024; 251:109942. [PMID: 38570066 DOI: 10.1016/j.neuropharm.2024.109942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Epilepsy is a neurological disorder characterised by unprovoked, repetitive seizures caused by abnormal neuronal firing. The Wnt/β-Catenin signalling pathway is involved in seizure-induced neurogenesis, aberrant neurogenesis, neuroinflammation, and hyperexcitability associated with epileptic disorder. Wnt/β-Catenin signalling is crucial for early brain development processes including neuronal patterning, synapse formation, and N-methyl-d-aspartate receptor (NMDAR) regulation. Disruption of molecular networks such as Wnt/β-catenin signalling in epilepsy could offer encouraging anti-epileptogenic targets. So, with a better understanding of the canonical Wnt/-Catenin pathway, we highlight in this review the important elements of Wnt/-Catenin signalling specifically in Mesial Temporal Lobe Epilepsy (MTLE) for potential therapeutic targets.
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Affiliation(s)
- Priya
- Dr. B.R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Nitin Yadav
- Dr. B.R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Sneha Anand
- Dr. B.R Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Jyotirmoy Banerjee
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Jardim AP, Duarte JTC, Lancellotti CLP, Carrete H, Centeno RS, Scorza CA, Cavalheiro EA, Guaranha MSB, Yacubian EMT. Granule cell dispersion is associated with hippocampal neuronal cell loss, initial precipitating injury, and other clinical features in mesial temporal lobe epilepsy and hippocampal sclerosis. Seizure 2021; 90:60-66. [PMID: 34162493 DOI: 10.1016/j.seizure.2021.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/18/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To characterize a 10-year series of patients with mesial temporal lobe epilepsy (MTLE) and unilateral hippocampal sclerosis (HS) and determine the histopathological characteristic of the association between granule cell dispersion (GCD) and hippocampal neuronal loss. METHODS The study included 108 MTLE/HS patients. Histopathological analyses were performed in NeuN-stained hippocampal sections for HS pattern, neuronal density, dentate gyrus (DG) pathology, and granule cell layer width. Statistical tests investigated the association between DG pathologies and HS patterns, as well as the correlation of DG width with total hippocampal and subfield-specific neuronal densities. RESULTS Fifty-six patients (51.9%) presented right HS. All the four ILAE HS patterns were represented (90 Type 1, 11 Type 2, 2 Type 3, and 5 no-HS). Sixty-seven patients (62.0%) presented GCD, 39 (36.1%) normal DG, and 2 (1.9%) narrow DG. GCD was associated with initial precipitating injury, higher numbers of monthly focal seizures and lifetime bilateral tonic-clonic seizures, longer epilepsy duration, and older age at surgery. GCD was prevalent in all HS patterns, except for Type 2 (81.8% normal versus 18.2% GCD, p = 0.005). GCD was associated with total hippocampal and subfield-specific neuronal loss, except for CA1. DG width correlated with total hippocampal (r = -0.201, p = 0.037) and CA4 neuronal densities (r = -0.299, p = 0.002). Patients with HS Type 1 had better surgical outcomes, with 51 (61.4%) seizure-free in the first year post-surgery. CONCLUSIONS This study confirmed that seizure control in MTLE/HS patients submitted to surgical treatment is comparable worldwide. Moreover, histopathological analyses showed an association between GCD and hippocampal neuronal loss, especially in the CA4 subfield.
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Affiliation(s)
- Anaclara Prada Jardim
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil.
| | - Jeana Torres Corso Duarte
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | | | - Henrique Carrete
- Diagnostic Imaging Sector, Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Ricardo Silva Centeno
- Neurosurgery Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Carla Alessandra Scorza
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Esper Abrão Cavalheiro
- Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Mirian Salvadori Bittar Guaranha
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - Elza Márcia Targas Yacubian
- Unidade de Pesquisa e Tratamento das Epilepsias, Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Brazil
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Toscano ECDB, Vieira ÉLM, Portela ACDC, Caliari MV, Brant JAS, Giannetti AV, Suemoto CK, Leite REP, Nitrini R, Rachid MA, Teixeira AL. Microgliosis is associated with visual memory decline in patients with temporal lobe epilepsy and hippocampal sclerosis: A clinicopathologic study. Epilepsy Behav 2020; 102:106643. [PMID: 31805504 DOI: 10.1016/j.yebeh.2019.106643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 01/14/2023]
Abstract
Hippocampal sclerosis (HS) is characterized by neuronal loss and gliosis. The intensity and distribution of these histopathological findings over the Cornu Ammonis (CA) subfields are important for the classification of HS and prognostication of patients with temporal lobe epilepsy (TLE). Several studies have associated the neuronal density reduction in the hippocampus with cognitive decline in patients with TLE. The current study aimed at investigating whether the expression of glial proteins in sclerotic hippocampi is associated with presurgical memory performance of patients with TLE. Before amygdalohippocampectomy, patients were submitted to memory tests. Immunohistochemical and morphometric analyses with glial fibrillary acidic protein (GFAP) for astrogliosis and human leucocyte antigen DR (HLA-DR) for microgliosis were performed in paraffin-embedded HS and control hippocampi. Sclerotic hippocampi exhibited increased gliosis in comparison with controls. In patients with TLE, the area and intensity of staining for HLA-DR were associated with worse performance in the memory tests. Glial fibrillary acidic protein was neither associated nor correlated with memory test performance. Our data suggest association between microgliosis, but not astrogliosis, with visual memory decline in patients with TLE.
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Affiliation(s)
- Eliana Cristina de Brito Toscano
- Departamento de Patologia Geral do Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Érica Leandro Marciano Vieira
- Neuroscience Division, Interdisciplinary Laboratory of Medical Investigation, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Marcelo Vidigal Caliari
- Departamento de Patologia Geral do Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | - Claudia Kimie Suemoto
- Laboratório de Fisiopatologia no Envelhecimento, Universidade de São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Laboratório de Fisiopatologia no Envelhecimento, Universidade de São Paulo, SP, Brazil
| | - Milene Alvarenga Rachid
- Departamento de Patologia Geral do Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Antônio Lúcio Teixeira
- Neuropsychiatry Program and Immuno-Psychiatry Lab, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, United States
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Olivares-Granados G, Ríos-Pelegrina RM, Ruiz-Giménez J, Galdón-Castillo A, Escobar-Delgado T, García del Moral R. Definición clínico-patológica de los subtipos de epilepsia temporal medial con esclerosis del hipocampo. Neurocirugia (Astur) 2018; 29:9-17. [DOI: 10.1016/j.neucir.2017.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/24/2017] [Indexed: 01/02/2023]
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Kasper BS, Vaccarella M. Is epilepsy surgery a threat to a patient's self? A conversation. Epilepsy Behav 2017; 75:264-268. [PMID: 28827042 DOI: 10.1016/j.yebeh.2017.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/19/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Burkhard S Kasper
- Friedrich-Alexander University Erlangen-Nuremberg, Dept. Neurology, Epilepsy Center, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Maria Vaccarella
- Lecturer in Medical Humanities, Department of English, University of Bristol, 3/5 Woodland Road, Bristol, BS8 1TB, United Kingdom.
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Schmeiser B, Hammen T, Steinhoff B, Zentner J, Schulze-Bonhage A. Long-term outcome characteristics in mesial temporal lobe epilepsy with and without associated cortical dysplasia. Epilepsy Res 2016; 126:147-56. [DOI: 10.1016/j.eplepsyres.2016.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
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Coras R, Blümcke I. Clinico-pathological subtypes of hippocampal sclerosis in temporal lobe epilepsy and their differential impact on memory impairment. Neuroscience 2015; 309:153-61. [DOI: 10.1016/j.neuroscience.2015.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/30/2015] [Accepted: 08/02/2015] [Indexed: 12/26/2022]
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Johnson AM, Sugo E, Barreto D, Cunningham AM, Hiew CC, Lawson JA, Somerville ER, Connolly AM, Bye AME. Response to "About focal cortical dysplasia (FCD) type IIIa". Epilepsy Res 2014; 108:1958-9. [PMID: 25449364 DOI: 10.1016/j.eplepsyres.2014.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alexandra M Johnson
- Sydney Children's Hospitals Network (Randwick), High Street, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia.
| | - Ella Sugo
- South Eastern Area Laboratory Services, Barker Street, Randwick, Sydney, NSW 2031, Australia; Prince of Wales Hospital, High Street, Randwick, Sydney, NSW 2031, Australia.
| | - Daniela Barreto
- Sydney Children's Hospitals Network (Randwick), High Street, Randwick, Sydney, NSW 2031, Australia.
| | - Anne M Cunningham
- Sydney Children's Hospitals Network (Randwick), High Street, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia.
| | - Chee-Chung Hiew
- Prince of Wales Hospital, High Street, Randwick, Sydney, NSW 2031, Australia.
| | - John A Lawson
- Sydney Children's Hospitals Network (Randwick), High Street, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia.
| | - Ernest R Somerville
- University of New South Wales, NSW 2052, Australia; Prince of Wales Hospital, High Street, Randwick, Sydney, NSW 2031, Australia.
| | - Anne M Connolly
- Sydney Children's Hospitals Network (Randwick), High Street, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia.
| | - Annie M E Bye
- Sydney Children's Hospitals Network (Randwick), High Street, Randwick, Sydney, NSW 2031, Australia; University of New South Wales, NSW 2052, Australia.
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Cendes F, Sakamoto AC, Spreafico R, Bingaman W, Becker AJ. Epilepsies associated with hippocampal sclerosis. Acta Neuropathol 2014; 128:21-37. [PMID: 24823761 DOI: 10.1007/s00401-014-1292-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 01/22/2023]
Abstract
Hippocampal sclerosis (HS) is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy (MTLE). Hippocampal specimens of pharmacoresistant MTLE patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. However, classification issues of hippocampal lesion patterns have been a matter of intense debate. International consensus classification has only recently provided significant progress for comparisons of neurosurgical and clinic-pathological series between different centers. The respective four-tiered classification system of the International League Against Epilepsy subdivides HS into three types and includes a term of "gliosis only, no-HS". Future studies will be necessary to investigate whether each of these subtypes of HS may be related to different etiological factors or with postoperative memory and seizure outcome. Molecular studies have provided potential deeper insights into the pathogenesis of HS and MTLE on the basis of epilepsy-surgical hippocampal specimens and corresponding animal models. These include channelopathies, activation of NMDA receptors, and other conditions related to Ca(2+) influx into neurons, the imbalance of Ca(2+)-binding proteins, acquired channelopathies that increase neuronal excitability, paraneoplastic and non-paraneoplastic inflammatory events, and epigenetic regulation promoting or facilitating hippocampal epileptogenesis. Genetic predisposition for HS is clearly suggested by the high incidence of family history in patients with HS, and by familial MTLE with HS. So far, it is clear that HS is multifactorial and there is no individual pathogenic factor either necessary or sufficient to generate this intriguing histopathological condition. The obvious variety of pathogenetic combinations underlying HS may explain the multitude of clinical presentations, different responses to clinical and surgical treatment. We believe that the stratification of neuropathological patterns can help to characterize specific clinic-pathological entities and predict the postsurgical seizure control in an improved fashion.
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Coras R, Pauli E, Li J, Schwarz M, Rössler K, Buchfelder M, Hamer H, Stefan H, Blumcke I. Differential influence of hippocampal subfields to memory formation: insights from patients with temporal lobe epilepsy. Brain 2014; 137:1945-57. [DOI: 10.1093/brain/awu100] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Whole mitochondrial DNA variations in hippocampal surgical specimens and blood samples with high-throughput sequencing: A case of mesial temporal lobe epilepsy with hippocampal sclerosis. Gene 2013; 529:190-4. [DOI: 10.1016/j.gene.2013.06.077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/13/2013] [Accepted: 06/20/2013] [Indexed: 11/22/2022]
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Blumcke I, Cross JH, Spreafico R. The international consensus classification for hippocampal sclerosis: an important step towards accurate prognosis. Lancet Neurol 2013; 12:844-846. [DOI: 10.1016/s1474-4422(13)70175-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Blümcke I, Thom M, Aronica E, Armstrong DD, Bartolomei F, Bernasconi A, Bernasconi N, Bien CG, Cendes F, Coras R, Cross JH, Jacques TS, Kahane P, Mathern GW, Miyata H, Moshé SL, Oz B, Özkara Ç, Perucca E, Sisodiya S, Wiebe S, Spreafico R. International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a Task Force report from the ILAE Commission on Diagnostic Methods. Epilepsia 2013; 54:1315-29. [PMID: 23692496 DOI: 10.1111/epi.12220] [Citation(s) in RCA: 657] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 12/23/2022]
Abstract
Hippocampal sclerosis (HS) is the most frequent histopathology encountered in patients with drug-resistant temporal lobe epilepsy (TLE). Over the past decades, various attempts have been made to classify specific patterns of hippocampal neuronal cell loss and correlate subtypes with postsurgical outcome. However, no international consensus about definitions and terminology has been achieved. A task force reviewed previous classification schemes and proposes a system based on semiquantitative hippocampal cell loss patterns that can be applied in any histopathology laboratory. Interobserver and intraobserver agreement studies reached consensus to classify three types in anatomically well-preserved hippocampal specimens: HS International League Against Epilepsy (ILAE) type 1 refers always to severe neuronal cell loss and gliosis predominantly in CA1 and CA4 regions, compared to CA1 predominant neuronal cell loss and gliosis (HS ILAE type 2), or CA4 predominant neuronal cell loss and gliosis (HS ILAE type 3). Surgical hippocampus specimens obtained from patients with TLE may also show normal content of neurons with reactive gliosis only (no-HS). HS ILAE type 1 is more often associated with a history of initial precipitating injuries before age 5 years, with early seizure onset, and favorable postsurgical seizure control. CA1 predominant HS ILAE type 2 and CA4 predominant HS ILAE type 3 have been studied less systematically so far, but some reports point to less favorable outcome, and to differences regarding epilepsy history, including age of seizure onset. The proposed international consensus classification will aid in the characterization of specific clinicopathologic syndromes, and explore variability in imaging and electrophysiology findings, and in postsurgical seizure control.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
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Affiliation(s)
- Ciğdem Ozkara
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
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Affiliation(s)
- Jerome Engel
- Department of Neurology, UCLA, Los Angeles, CA, USA.
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Luther N, Rubens E, Sethi N, Kandula P, Labar DR, Harden C, Perrine K, Christos PJ, Iorgulescu JB, Lancman G, Schaul NS, Kolesnik DV, Nouri S, Dawson A, Tsiouris AJ, Schwartz TH. The value of intraoperative electrocorticography in surgical decision making for temporal lobe epilepsy with normal MRI. Epilepsia 2011; 52:941-8. [PMID: 21480886 DOI: 10.1111/j.1528-1167.2011.03061.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We hypothesized that acute intraoperative electrocorticography (ECoG) might identify a subset of patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) who could proceed directly to standard anteromesial resection (SAMR), obviating the need for chronic electrode implantation to guide resection. METHODS Patients with TLE and a normal MRI who underwent acute ECoG prior to chronic electrode recording of ictal onsets were evaluated. Intraoperative interictal spikes were classified as mesial (M), lateral (L), or mesial/lateral (ML). Results of the acute ECoG were correlated with the ictal-onset zone following chronic ECoG. Onsets were also classified as "M,""L," or "ML." Positron emission tomography (PET), scalp-EEG (electroencephalography), and Wada were evaluated as adjuncts. KEY FINDINGS Sixteen patients fit criteria for inclusion. Outcomes were Engel class I in nine patients, Engel II in two, Engel III in four, and Engel IV in one. Mean postoperative follow-up was 45.2 months. Scalp EEG and PET correlated with ictal onsets in 69% and 64% of patients, respectively. Wada correlated with onsets in 47% of patients. Acute intraoperative ECoG correlated with seizure onsets on chronic ECoG in all 16 patients. All eight patients with "M" pattern ECoG underwent SAMR, and six (75%) experienced Engel class I outcomes. Three of eight patients with "L" or "ML" onsets (38%) had Engel class I outcomes. SIGNIFICANCE Intraoperative ECoG may be useful in identifying a subset of patients with MRI-negative TLE who will benefit from SAMR without chronic implantation of electrodes. These patients have uniquely mesial interictal spikes and can go on to have improved postoperative seizure-free outcomes.
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Affiliation(s)
- Neal Luther
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York 10065, USA
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Yang T, Zhou D, Stefan H. Why mesial temporal lobe epilepsy with hippocampal sclerosis is progressive: uncontrolled inflammation drives disease progression? J Neurol Sci 2010; 296:1-6. [PMID: 20663517 DOI: 10.1016/j.jns.2010.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 05/28/2010] [Accepted: 06/02/2010] [Indexed: 02/05/2023]
Abstract
Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a group of chronic disorders characterized by prominent neuronal loss and gliosis in the hippocampus and amygdala. Newly published data indicate that it may be a progressive disease, but the mechanism underlying the progressive nature remains unknown. Recently, substantial evidence for an inflammatory mechanism in MTLE has been documented. We are therefore presenting a review of literature concerning the effects of uncontrolled inflammation on the disease progression of MTLE-HS. We found that increasing amounts of evidence support the association between uncontrolled inflammation and progression of the disease. Uncontrolled inflammatory processes may be a main mechanism underlying the self-propagating cycle of uncontrolled inflammation, blood-brain barrier damage, and seizures that drive the progressive nature. Thus it is important to unravel the principles of communication between the different factors in this cycle. The dynamic modulation of inflammatory processes aimed at preventing or interrupting this cycle has the potential to emerge as a novel therapeutic strategy. This line of therapy might offer new perspectives on the pharmacologic treatment of seizures, and possibly on delaying disease progression or retarding epileptogenesis as well.
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Affiliation(s)
- Tianhua Yang
- Department of Neurology, West China Hospital, Si Chuan University, Cheng du, Sichuan, China
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Autobiographical memory in temporal lobe epilepsy: role of hippocampal and temporal lateral structures. Epilepsy Behav 2010; 19:365-71. [PMID: 20875774 DOI: 10.1016/j.yebeh.2010.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 07/10/2010] [Accepted: 07/17/2010] [Indexed: 01/26/2023]
Abstract
The present study was aimed at investigating the impact of hippocampal and temporal cortical lesions on remote autobiographical memories in temporal lobe epilepsy (TLE). Episodic specificity, episodic richness, and personal semantic memory from different life periods were assessed using a modified version of the Autobiographical Memory Interview (AMI) (M.D. Kopelman, A.E. Wilson, A. Baddeley, The autobiographical memory interview. Bury St. Edmunds: Thames Valley Test Co.; 1990) in 47 patients with unilateral mesial or lateral TLE and 38 healthy controls. Patients with TLE performed significantly more poorly than controls. Patients with left and right mTLE were equally moderately impaired, but patients with left lateral TLE had the most severe episodic memory deficits, particularly for childhood memories. With respect to personal semantic memory, patients with left TLE were significantly more impaired than those with right TLE, most pronounced for childhood memories. Both autobiographical memory aspects, episodic and personal semantic memory, were significantly intercorrelated, but both did not correlate with anterograde memory, indicating a structural dissociation between both functions.
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Coras R, Siebzehnrubl FA, Pauli E, Huttner HB, Njunting M, Kobow K, Villmann C, Hahnen E, Neuhuber W, Weigel D, Buchfelder M, Stefan H, Beck H, Steindler DA, Blümcke I. Low proliferation and differentiation capacities of adult hippocampal stem cells correlate with memory dysfunction in humans. Brain 2010; 133:3359-72. [PMID: 20719879 DOI: 10.1093/brain/awq215] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The hippocampal dentate gyrus maintains its capacity to generate new neurons throughout life. In animal models, hippocampal neurogenesis is increased by cognitive tasks, and experimental ablation of neurogenesis disrupts specific modalities of learning and memory. In humans, the impact of neurogenesis on cognition remains unclear. Here, we assessed the neurogenic potential in the human hippocampal dentate gyrus by isolating adult human neural stem cells from 23 surgical en bloc hippocampus resections. After proliferation of the progenitor cell pool in vitro we identified two distinct patterns. Adult human neural stem cells with a high proliferation capacity were obtained in 11 patients. Most of the cells in the high proliferation capacity cultures were capable of neuronal differentiation (53 ± 13% of in vitro cell population). A low proliferation capacity was observed in 12 specimens, and only few cells differentiated into neurons (4 ± 2%). This was reflected by reduced numbers of proliferating cells in vivo as well as granule cells immunoreactive for doublecortin, brain-derived neurotrophic factor and cyclin-dependent kinase 5 in the low proliferation capacity group. High and low proliferation capacity groups differed dramatically in declarative memory tasks. Patients with high proliferation capacity stem cells had a normal memory performance prior to epilepsy surgery, while patients with low proliferation capacity stem cells showed severe learning and memory impairment. Histopathological examination revealed a highly significant correlation between granule cell loss in the dentate gyrus and the same patient's regenerative capacity in vitro (r = 0.813; P < 0.001; linear regression: R²(adjusted) = 0.635), as well as the same patient's ability to store and recall new memories (r = 0.966; P = 0.001; linear regression: R²(adjusted) = 0.9). Our results suggest that encoding new memories is related to the regenerative capacity of the hippocampus in the human brain.
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Affiliation(s)
- Roland Coras
- University Hospital Erlangen, Schwabachanlage 6, D - 91054 Erlangen, Germany
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Increased spike frequency during general anesthesia with etomidate for magnetoencephalography in patients with focal epilepsies. Clin Neurophysiol 2010; 121:1220-6. [DOI: 10.1016/j.clinph.2010.02.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 12/30/2009] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
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Enhanced activity during associative encoding in the affected hippocampus in right temporal lobe epilepsy patients. Brain Res 2009; 1297:112-7. [PMID: 19699186 DOI: 10.1016/j.brainres.2009.08.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 08/07/2009] [Accepted: 08/09/2009] [Indexed: 11/21/2022]
Abstract
Mnestic deficits represent the core cognitive impairment of patients with temporal lobe epilepsy (TLE), irrespective of the existence of overt morphological lesions. Compared to controls, patients with symptomatic TLE show altered functional activation patterns in fMRI studies on memory processes. But, so far, such studies have rarely investigated patients with temporal lobe epilepsy of unknown cause. Therefore, in the current study, a small sample of 6 right TLE patients with normal structural MRIs was compared to controls with respect to brain activity during encoding of face-name associations using fMRI. Compared to controls, patients retrieved fewer face-name associations correctly, but showed significantly greater activation of the affected hippocampus for successfully encoded stimuli. Therefore, higher hippocampal activation seems necessary for successful encoding of associations in patients compared to controls. But, this process is not entirely successful since the patients cannot achieve the same performance as controls. In conclusion, the hyperactivation of the hippocampus might represent a compensational but inefficient process.
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Pauli E, Stefan H. Emotional-affektive Störungen bei Epilepsien. DER NERVENARZT 2009; 80:729-44. [DOI: 10.1007/s00115-008-2628-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Towards a clinico-pathological classification of granule cell dispersion in human mesial temporal lobe epilepsies. Acta Neuropathol 2009; 117:535-44. [PMID: 19277686 DOI: 10.1007/s00401-009-0512-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 03/02/2009] [Accepted: 03/02/2009] [Indexed: 10/21/2022]
Abstract
The dentate gyrus (DG) plays a pivotal role in the functional and anatomical organization of the hippocampus and is involved in learning and memory formation. However, the impact of structural DG abnormalities, i.e., granule cell dispersion (GCD), for hippocampal seizure susceptibility and its association with distinct lesion patterns in epileptic disorders, such as mesial temporal sclerosis (MTS) remains enigmatic and a large spectrum of pathological changes has been recognized. Here, we propose a clinico-pathological classification of DG pathology based on the examination of 96 surgically resected hippocampal specimens obtained from patients with chronic temporal lobe epilepsy (TLE). We observed three different histological patterns. (1) A normal granule cell layer was identified in 11 patients (no-GCP; 18.7%). (2) Substantial granule cell loss was evident in 36 patients (referred to as granule cell pathology (GCP) Type 1; 37.5%). (3) Architectural abnormalities were observed in 49 specimens, including one or more of the following features: granule cell dispersion, ectopic neurons or clusters of neurons in the molecular layer, or bi-lamination (GCP Type 2; 51%). Cell loss was always encountered in this latter cohort. Seventy-eight patients of our present series suffered from MTS (81.3%). Intriguingly, all MTS patients displayed a compromised DG, 31 (40%) with significant cell loss (Type 1) and 47 (60%) with GCD (Type 2). In 18 patients without MTS (18.7%), seven displayed focally restricted DG abnormalities, either cell loss (n = 5) or GCD (n = 2). Clinical histories revealed a significant association between DG pathology patterns and higher age at epilepsy surgery (p = 0.008), longer epilepsy duration (p = 0.004), but also with learning dysfunction (p < 0.05). There was no correlation with the extent of pyramidal cell loss in adjacent hippocampal segments nor with postsurgical seizure relief. The association with long-term seizure histories and cognitive dysfunction is remarkable and may point to a compromised regenerative capacity of the DG in this cohort of TLE patients.
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Intracarotid propofol testing: a comparative study with amobarbital. Epilepsy Behav 2009; 14:503-7. [PMID: 19162226 DOI: 10.1016/j.yebeh.2008.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/18/2008] [Accepted: 12/25/2008] [Indexed: 11/23/2022]
Abstract
Twenty-five consecutive patients who underwent the Wada test using propofol as anesthetic were compared with 15 randomly selected patients who were tested using amobarbital. Time to verbal and nonverbal responses and time to motor power 3/5 did not differ between the two groups (P>0.05). The number of doses received by each patient and the percentage of patients needing more than one dose were significantly greater in the propofol group (P<0.005). Only one patient developed confusion, combativeness, and agitation. Despite the need for multiple doses, our patients had no residual drowsiness within 10 to 15 minutes of the propofol injection. This allowed us to perform the test on both sides on the same day separated only by 45 minutes. Propofol is an effective alternative to amobarbital in the Wada test, and may be used successfully in multiple repeated injections within the same test without significant residual sedation or significant adverse effects.
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