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Abstract：
OBJECTIVE: Mesial temporal lobe epilepsy with hippocampal sclerosis is the most common cause of refractory epilepsy, and the most common indication for surgery. Although effective, surgery fails in up to 40% of patients. The objective of our study was to establish a correlation between the different histological subtypes of mesial temporal lobe epilepsy with hippocampal sclerosis and the prognosis, seizures control, side effects and anticonvulsivant drug withdrawal in patients with refractory epilepsy.
METHODS: Clinical histories and anatomopathological specimens of 228 patients with temporal epilepsy surgically obtained at our hospital between 1993 and 2014 were retrospectively analysed. All patients underwent a standard preoperative evaluation and anterior temporal resection (modified from Spencer). The anatomopathological study included the standard hematoxylin-eosin and immunohistochemical protocol, with special interest in the assessment of neuronal loss with NeuN. Seizure control was assessed according to the scale of results of the ILAE and Engel. The mean follow-up was 8.6 years (2-19).
RESULTS: At 10 years after the intervention, 67.9% of patients were seizure-free (ILAE 1) and as many as 77.5% of the patients were seizure-free (Engel 1) at the end of the follow-up. The probability of not having a seizure (ILAE 1) after surgery at 2 (p=.042), 5 (p=.001) and 7 years (p=.22) was higher in classic and severe forms compared to isolated sclerosis CA1 and CA4 forms. Higher neuronal loss measured with the NeuN immunostain in CA1 was associated with better outcome in seizure management (multivariate analysis, p=.08). The presence of a personal history of epilepsy was associated with greater neuronal loss in CA1 (p=.028) and CA3 (p=.034), and the presence of psychic auras was related with greater neuronal loss in CA3 (p=.025). In our case, the probability of medication withdrawal was related to the presence of personal history (p=.003) and, inversely, to neuronal loss in CA1 (p=.036) and CA3 (p=.038). The greatest impairment of verbal memory occurred in those patients with a lower neuronal loss in CA1 (p=.023), CA2 (p=.049) and CA3 (p=.035).
CONCLUSIONS: The results indicate that the classical and severe subtypes have a better prognosis in the control of seizures against the atypical forms, validating the clinical and prognostic utility of the classification of histological subtypes of hippocampal sclerosis from the ILAE. The value of the immunohistochemistry in the mesial temporal lobe epilepsy with hippocampal sclerosis has been demonstrated as a key element to determine the neuropsychological prognosis and seizure management of the patients after surgery.
METHODS: Clinical histories and anatomopathological specimens of 228 patients with temporal epilepsy surgically obtained at our hospital between 1993 and 2014 were retrospectively analysed. All patients underwent a standard preoperative evaluation and anterior temporal resection (modified from Spencer). The anatomopathological study included the standard hematoxylin-eosin and immunohistochemical protocol, with special interest in the assessment of neuronal loss with NeuN. Seizure control was assessed according to the scale of results of the ILAE and Engel. The mean follow-up was 8.6 years (2-19).
RESULTS: At 10 years after the intervention, 67.9% of patients were seizure-free (ILAE 1) and as many as 77.5% of the patients were seizure-free (Engel 1) at the end of the follow-up. The probability of not having a seizure (ILAE 1) after surgery at 2 (p=.042), 5 (p=.001) and 7 years (p=.22) was higher in classic and severe forms compared to isolated sclerosis CA1 and CA4 forms. Higher neuronal loss measured with the NeuN immunostain in CA1 was associated with better outcome in seizure management (multivariate analysis, p=.08). The presence of a personal history of epilepsy was associated with greater neuronal loss in CA1 (p=.028) and CA3 (p=.034), and the presence of psychic auras was related with greater neuronal loss in CA3 (p=.025). In our case, the probability of medication withdrawal was related to the presence of personal history (p=.003) and, inversely, to neuronal loss in CA1 (p=.036) and CA3 (p=.038). The greatest impairment of verbal memory occurred in those patients with a lower neuronal loss in CA1 (p=.023), CA2 (p=.049) and CA3 (p=.035).
CONCLUSIONS: The results indicate that the classical and severe subtypes have a better prognosis in the control of seizures against the atypical forms, validating the clinical and prognostic utility of the classification of histological subtypes of hippocampal sclerosis from the ILAE. The value of the immunohistochemistry in the mesial temporal lobe epilepsy with hippocampal sclerosis has been demonstrated as a key element to determine the neuropsychological prognosis and seizure management of the patients after surgery.
摘要：
目的：内侧颞叶癫痫伴海马硬化是难治性癫痫的最常见原因，和最常见的手术适应症。虽然有效,高达40%的患者手术失败。我们的研究目的是建立不同组织学亚型的颞叶内侧癫痫伴海马硬化与预后的相关性。控制癫痫发作,难治性癫痫患者的副作用和抗惊厥药物戒断。
方法：回顾性分析1993年至2014年在我院手术获得的228例颞叶癫痫患者的临床病史和解剖病理学标本。所有患者均接受了标准的术前评估和颞前切除术（由Spencer修改）。解剖病理学研究包括标准的苏木精-伊红和免疫组织化学方案，对使用NeuN评估神经元丢失特别感兴趣。根据ILAE和Engel的结果量表评估癫痫发作控制。平均随访时间为8.6年（2-19年）。
结果：干预后10年，67.9％的患者无癫痫发作（ILAE1），多达77.5％的患者在随访结束时无癫痫发作（Engel1）。手术后2时没有癫痫发作（ILAE1）的概率（p=.042），5（p=.001）和7年（p=.22）在经典和严重形式中与孤立性硬化症CA1和CA4形式相比更高。用NeuN免疫染色在CA1中测量的更高的神经元损失与癫痫发作管理中更好的结果相关(多变量分析，p=.08）。癫痫的个人病史的存在与CA1（p=0.028）和CA3（p=0.034）中更大的神经元丢失有关，精神光环的存在与CA3中更大的神经元丢失有关（p=0.025）。在我们的案例中,停药的可能性与个人病史的存在有关（p=0.003），相反，CA1(p=.036)和CA3(p=.038)中的神经元丢失。语言记忆的最大损害发生在CA1神经元丢失较低的患者中（p=0.023），CA2(p=.049)和CA3(p=.035)。
结论：结果表明，经典和严重亚型在控制癫痫发作方面具有更好的预后，验证ILAE海马硬化组织学亚型分类的临床和预后实用性。已证明免疫组织化学在海马硬化的颞叶内侧癫痫中的价值是确定手术后患者神经心理学预后和癫痫发作管理的关键要素。
方法：回顾性分析1993年至2014年在我院手术获得的228例颞叶癫痫患者的临床病史和解剖病理学标本。所有患者均接受了标准的术前评估和颞前切除术（由Spencer修改）。解剖病理学研究包括标准的苏木精-伊红和免疫组织化学方案，对使用NeuN评估神经元丢失特别感兴趣。根据ILAE和Engel的结果量表评估癫痫发作控制。平均随访时间为8.6年（2-19年）。
结果：干预后10年，67.9％的患者无癫痫发作（ILAE1），多达77.5％的患者在随访结束时无癫痫发作（Engel1）。手术后2时没有癫痫发作（ILAE1）的概率（p=.042），5（p=.001）和7年（p=.22）在经典和严重形式中与孤立性硬化症CA1和CA4形式相比更高。用NeuN免疫染色在CA1中测量的更高的神经元损失与癫痫发作管理中更好的结果相关(多变量分析，p=.08）。癫痫的个人病史的存在与CA1（p=0.028）和CA3（p=0.034）中更大的神经元丢失有关，精神光环的存在与CA3中更大的神经元丢失有关（p=0.025）。在我们的案例中,停药的可能性与个人病史的存在有关（p=0.003），相反，CA1(p=.036)和CA3(p=.038)中的神经元丢失。语言记忆的最大损害发生在CA1神经元丢失较低的患者中（p=0.023），CA2(p=.049)和CA3(p=.035)。
结论：结果表明，经典和严重亚型在控制癫痫发作方面具有更好的预后，验证ILAE海马硬化组织学亚型分类的临床和预后实用性。已证明免疫组织化学在海马硬化的颞叶内侧癫痫中的价值是确定手术后患者神经心理学预后和癫痫发作管理的关键要素。
