Epilepsy, Temporal Lobe

癫痫,颞叶
  • 文章类型: Journal Article
    The distribution of hippocampal sclerosis (HS) subtypes, according to the classification of the International League Against Epilepsy (ILAE), has been reported mainly in adult patients. We aimed to review the pathological findings in children who had anterior temporal lobectomy accompanied with amygdalohippocampectomy, in view of the current classification, and evaluate postsurgical outcome with respect to HS subtypes in childhood.
    Seventy children who underwent temporal resections for treatment of medically refractory epilepsy, with a minimum follow-up of 2 years, were included; the surgical hippocampus specimens were re-evaluated under the HS ILAE classification.
    Neuropathological evaluations revealed HS type 1 in 38 patients (54.3%), HS type 2 in 2 (2.8%), HS type 3 in 21 patients (30%), and no HS in 9 patients (12.9%). Of 70 patients, 23 (32.9%) had dual pathology, and the most common pattern was HS type 3 with low-grade epilepsy-associated brain tumors (LEAT). The distribution of HS types with respect to age revealed that HS type 3 and no HS subgroups had significantly more patients younger than 12 years, compared with those of HS type 1 (90.5%, 77.8% vs 47.4%, respectively). History of febrile seizures was higher in HS type 1. Prolonged/recurrent febrile seizures were most common in patients 12 years and older, whereas LEAT was the most common etiology in patients under 12 years of age (p < 0.001). Patients with HS type 1 had longer duration of epilepsy and an older age at the time of surgery compared with patients with HS type 3 and no HS (p: 0.031, p: 0.007). At final visit, 74.3% of the patients were seizure-free. Seizure outcome showed no significant difference between pathological subtypes.
    Our study presents the distribution of HS ILAE subtypes in an exclusively pediatric series along with long-term seizure outcome. The study reveals that the leading pathological HS subgroup in children is HS type 1, similar with adult series. Hippocampal sclerosis type 2 is significantly less in children compared with adults; however, HS type 3 emerges as the second most predominant group because of dual pathology, particularly LEAT. Further studies are required regarding clinicopathological features of isolated HS in pediatric cohort. Seizure-free outcome was favorable and similar in all HS types in children. The proportion of HS types may be better defined in pediatric patients with temporal resections, as the current HS ILAE classification becomes more widely used, and may help reveal the surgical and cognitive outcome with respect to HS types.
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  • 文章类型: Comparative Study
    OBJECTIVE: This study aims to compare stereotactic radiosurgery (SRS) planning of epilepsy that complies with Radiosurgery or Open Surgery for Epilepsy (ROSE) guidelines in GammaKnife, non-coplanar conformal (NCC) plan in Eclipse, dynamic conformal arc (DCA) plan in Brainlab, and a volumetric modulated arc therapy (VMAT) plan in Eclipse.
    METHODS: Twenty plans targeting Mesial temporal lobe epilepsy (MTLE) was generated using GammaKnife, Eclipse with 20 NCC beams, Brainlab with 5 DCA, and Eclipse VMAT with 4 arcs observing ROSE trial guidelines. Multivariate analysis of variance and Wilcoxon signed-rank test were used to compare dosimetric data of the plans and perform pairwise comparison, respectively.
    RESULTS: The plans obeyed the recommended prescription isodose volume (PIV) within 5.5-7.5 cc and maximum doses to brainstem, optic apparatus (OA) of 10 and 8 Gy, respectively, for a prescription dose of 24 Gy. The volumes of the target were in the range 4.0-7.4 cc. Mean PIV, maximum dose to brainstem, OA were 6.5 cc, 10 Gy, 7.9 Gy in GammaKnife; 7.2 cc, 6.1 Gy, 4.5 Gy in Eclipse NCC; 7.2 cc, 6.4 Gy, 5.7 Gy in Brainlab DCA; and 5.2 cc, 8.4 Gy, 6.1 Gy in Eclipse VMAT plans, respectively. Multivariate analysis of variance showed significant differences among the 4 SRS planning techniques (P-values < 0.01).
    CONCLUSIONS: Among the 4 SRS planning methods, VMAT with least PIV and acceptable maximum doses to brainstem and OA showed highest compliance with ROSE trial. Having the most conformal dose distribution and least dose inhomogeneity, VMAT scored higher than GK, Eclipse NCC, and Brainlab DCA plans.
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  • 文章类型: Journal Article
    海马硬化(HS)是耐药颞叶癫痫(TLE)患者最常见的组织病理学。在过去的几十年里,已经进行了各种尝试来对海马神经元细胞丢失的特定模式进行分类,并将亚型与术后结局相关联。然而,没有就定义和术语达成国际共识。工作组回顾了以前的分类方案,并提出了一种基于半定量海马细胞损失模式的系统,该系统可应用于任何组织病理学实验室。观察者之间和观察者之间的共识研究达成共识,可以在解剖保存完好的海马标本中对三种类型进行分类:HS国际抗癫痫联盟(ILAE)1型始终是指严重的神经元细胞丢失和神经胶质增生,主要在CA1和CA4区域,与CA1占优势的神经元细胞丢失和神经胶质增生(HSILAE2型)相比,或CA4占优势的神经元细胞丢失和神经胶质增生(HSILAE3型)。从TLE患者获得的手术海马标本也可能显示出正常的神经元含量,仅具有反应性神经胶质增生(无HS)。HSILAE1型通常与5岁之前的初始诱发性损伤史有关。早期癫痫发作,和良好的术后癫痫发作控制。迄今为止,对CA1为主的HSILAE2型和CA4为主的HSILAE3型的系统研究较少,但是一些报告指出不太有利的结果,关于癫痫史的差异,包括癫痫发作的年龄。拟议的国际共识分类将有助于表征特定的临床病理综合征,并探索成像和电生理学发现的变异性,以及术后癫痫发作控制。
    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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  • 文章类型: Journal Article
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  • DOI:
    文章类型: English Abstract
    The guidelines for the surgical treatment of the movement disorders and epilepsy have been performed by the functional and stereotactic group of the Spanish Society of Neurosugery (SENEC). The guidelines are recomendations in terms of indication for surgery including timing and methods. The format are supported by prospective studies based in scientific evidence and the expert opinion of the group.
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  • DOI:
    文章类型: Guideline
    These guidelines, developed by the Study Group on Functional Neurosurgery of the Italian Society of Neurosurgery, concern the minimum standard equipment and organization required to a center dealing with the surgical treatment of epilepsy. They include the general criteria for patient selection, the main presurgical diagnostic procedures able to define seizure characteristics and concomitant brain abnormalities, the standard surgical procedures utilized. \"Cryptogenetic\" as well as \"symptomatic\" epilepsies are considered. Recommendations are also provided for correct result assessment and follow-up evaluation. Guidelines presented here reflect a multidisciplinary consensus and expert opinion, based on scientific evidence and current clinical experience.
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    文章类型: Consensus Development Conference
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