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

Purpose: This study is a retrospective analysis of the pathology of the hippocampus from patients with medically intractable temporal lobe epilepsy. We attempted to relate neuronal density, immunohistochemistry, electrophysiologic data, and surgical outcome. Methods: Immunostaining patterns for neur...

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Bibliographic Details
Published in:Epilepsia (Copenhagen) 2003-05, Vol.44 (5), p.677-687
Main Authors: De Lanerolle, Nihal C., Kim, Jung H., Williamson, Anne, Spencer, Susan S., Zaveri, Hitten P., Eid, Toye, Spencer, Dennis D.
Format: Article
Language:English
Subjects:
Adult
Apoptosis - physiology
Biological and medical sciences
Cell Count
Culture Techniques
Dentate Gyrus - pathology
Dentate Gyrus - physiopathology
Dentate Gyrus - surgery
Dynorphins - analysis
Electroencephalography
Electrophysiology
Epilepsy, Temporal Lobe - classification
Epilepsy, Temporal Lobe - pathology
Epilepsy, Temporal Lobe - physiopathology
Epilepsy, Temporal Lobe - surgery
Evoked Potentials - physiology
Female
Follow-Up Studies
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Hippocampal cell counts
Hippocampus - pathology
Hippocampus - physiopathology
Hippocampus - surgery
Humans
Immunoenzyme Techniques
Immunohistochemistry
Interneurons - pathology
Interneurons - physiology
Male
Medical sciences
Mesial sclerosis
Nervous system (semeiology, syndromes)
Neurology
Neurons - pathology
Neurons - physiology
Neuropeptide Y - analysis
Paradoxical temporal lobe epilepsy
Reference Values
Retrospective Studies
Sclerosis
Somatostatin - analysis
Substance P - analysis
Treatment Outcome
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Summary:Purpose: This study is a retrospective analysis of the pathology of the hippocampus from patients with medically intractable temporal lobe epilepsy. We attempted to relate neuronal density, immunohistochemistry, electrophysiologic data, and surgical outcome. Methods: Immunostaining patterns for neuropeptide Y, somatostatin, substance P, and dynorphin defined the immunohistochemical characteristics of the hippocampi. Neuronal densities were determined by microscopic cell counts. Sharp electrode recordings from dentate granule cells determined measures of inhibition and excitation. Results: Patient hippocampi without evidence of sclerosis generally resembled autopsy controls on the basis of neuronal densities of hippocampal subfields and patterns of immunostaining. The nonsclerotic hippocampi were divisible into two subgroups on the basis of neuronal density correlations between hippocampal subfields, the excitability of dentate granule cells, etiology, and surgical outcome. Hippocampi with sclerosis were divisible into those with significant neuronal loss confined to area CA1 and those with neuronal loss throughout the hippocampus and dentate gyrus. In the former, the dentate gyrus resembled in morphology the nonsclerotic hippocampi but with slightly increased excitability of the dentate granule cells. The hippocampi with more extensive neuronal loss had changes in immunostaining patterns associated with the dentate gyrus, correlated with significant hyperexcitability of dentate granule cells. The surgical outcome, with the exception of one group, was good in ∼70–90%. Conclusions: Hippocampi from patients with intractable temporal lobe epilepsy can be assigned to several groups on the basis of pathophysiology. Different pathologies may represent differing causative mechanisms of intractable temporal lobe epilepsy and be predictive of surgical outcome.
ISSN:0013-9580
1528-1167
DOI:10.1046/j.1528-1157.2003.32701.x