Determining factors of the neuronal viability in hippocampal slices from patients with mesial temporal lobe epilepsy

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Orbitofrontal sulcal and gyrus pattern in human: an anatomical study

The anatomical characterization of the orbitofrontal cortex in human is limited in literature instead of many functional and clinical studies involving it. Objective: Anatomically define the orbitofrontal region aiming to possible neurosurgical treatments and unify the scientific nomenclature as well. Method: We analyze eighty four human hemispheres using a surgical microscope. Then we chose four hemispheres and dissect them according to Klinger' technique. Results: We found five main sulcus: olfatory sulcus, orbital medial sulcus, orbital lateral sulcus, orbital transverse sulcus and orbital intermediate sulcus. These sulcus, excluding the intermediate sulcus, delimit five gyrus: rectus gurys, orbital medial gyrus, orbital anterior gyrus, orbital lateral gyrus and orbital posterior gyrus. the main sulcal configuration can be divided on four more frequently patterns. Conclusion: Orbitofrontal cortex is associated with many psychiatric disorders. Better anatomical and functional characterization of the orbitofrontal cortex and its connections will improve our knowledge about these diseases.Universidade Federal de São Paulo, Escola Paulista Med, Disciplina Neurocirurgia, São Paulo, SP, BrazilHosp Albert Einstein, Disciplina Radiol, São Paulo, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Disciplina Neurocirurgia, São Paulo, SP, BrazilWeb of Scienc

Neurocisticercose e displasia hipocampal microscópica em paciente com epilepsia do lobo temporal mesial refratária

Epidemiologic studies suggest that neurocysticercosis (NC) is the main cause of symptomatic epilepsy in developing countries. The association between NC and mesial temporal lobe epilepsy (MTLE) has been reported by several authors. Recent data have shown that the presence of NC does not influence the clinical and pathological profile in MTLE patients and suggest that not all cysticercotic lesions are inevitably epileptogenic. We describe a 50-years-old woman with partial seizures due to NC which evolve to MTLE. The patient was submitted to a corticoamygdalohippocampectomy to treat refractory epilepsy. An immunohistochemical study using neuronal markers was made on hippocampal formation. Besides the typical aspects of Ammon's horn sclerosis (AHS), the microscopic examination demonstrates cellular features of hippocampal malformation including dysmorphic neurons and focal bilamination of granular cell layer. We suggest that, in this case, a developmental disorder lowered the threshold for the NC-induced seizures and contributed to the establishment of refractory epilepsy.Estudos epidemiológicos sugerem que a neurocisticercose (NC) é a causa principal de epilepsia sintomática em países em desenvolvimento. A associação entre NC e epilepsia do lobo temporal mesial (ELTM) tem sido relatada por vários autores. Estudos recentes mostraram que a presença de NC não influência o perfil clínico e patológico em pacientes com ELTM e sugere que nem todas as lesões cisticercóticas são inevitavelmente epileptogênicas. No presente estudo, descrevemos uma mulher de 50 anos com crises epilépticas parciais associadas à NC que evolui para ELTM. A paciente foi submetida à corticoamigdalohipocampectomia para tratamento de epilepsia refratária. O estudo imunohistoquímico, utilizando marcadores neuronais, foi realizado em seções da formação de hipocampal. Além dos aspectos típicos da esclerose hipocampal, o exame microscópico demonstrou características celulares de malformação hipocampal, incluindo neurônios dismórficos e bilaminação focal da camada granular do giro denteado. Sugerimos que, neste caso, um transtorno do desenvolvimento reduziu o limiar para as crises epilépticas induzidas pela NC e contribuiu para o estabelecimento da epilepsia refratária.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de Neurologia ExperimentalUNIFESP-EPM Departamento de Neurologia e NeurocirurgiaUNIFESP-EPM Departamento de Diagnóstico por ImagemUNIFESP-EPM Departamento de PatologiaUNIFESP, EPM, Laboratório de Neurologia ExperimentalUNIFESP, EPM Depto. de Neurologia e NeurocirurgiaUNIFESP, EPM Depto. de Diagnóstico por ImagemUNIFESP, EPM Depto. de PatologiaSciEL

Can intraoperative electrocorticography patterns predict surgical outcome in patients with temporal lobe epilepsy secondary to unilateral mesial temporal sclerosis?

Introduction: Intraoperative electrocorticography (ECoG) can be performed in cases of temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS). However, its significance and correlation with surgical outcome are still controversial.Objectives: To analyze the electrophysiological characteristics of temporal lobe structures during ECoG of patients with TLE-HS, with emphasis on the comparison between pre- and post-resection recordings and surgical outcome.Patients and methods: Seventeen patients with refractory TLE-HS submitted to corticoamigdalohipocampectomy were included in the study. Clinical variables included age at the onset, duration of epilepsy and seizure outcome. the postoperative follow-up ranged from 24 to 36 months. According to outcome subjects were divided in two subgroups: (A) individuals free of seizures (Engel 1A), and (B) individuals not-free of seizures (Engel 1B-IV). Four patterns of ECoG findings were identified: isolated discharges; high frequency spikes (HFS); continuous discharges; combination of isolated discharges and HFS. According to predominant topography ECoG was classified as mediobasal, lateral (or neocortical), mediobasal and lateral.Results: the progressive removal of the temporal pole and the hippocampus was associated with significant decrease of neocortical spikes. No correlation between clinical variables and seizure outcome was observed. Patients who only had isolated spikes on intraoperative ECoG presented a statistical trend for excellent surgical control. Patients who presented temporal pole blurring on MRI also had better post-surgical seizure outcome.Conclusions: This study showed that out of diverse clinical and laboratory variables, only isolated discharges on intraoperative ECoG and temporal pole blurring on MRI predicted excellent post-surgicat seizure outcome. However, other studies with larger number of patients are stilt necessary to confirm these findings. (C) 2006 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Universidade Federal de São Paulo, Dept Neurol & Neurosurg, Div Neurol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Radiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Div Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Anesthesiol, São Paulo, BrazilUniv São Paulo, Ribeirao Preto Med Sch, Dept Surg, Div Neurosurg, São Paulo, BrazilUniv São Paulo, Ribeirao Preto Med Sch, Dept Neurol Psychiat & Clin Psychol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Div Neurol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Radiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Div Neurosurg, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Anesthesiol, São Paulo, BrazilWeb of Scienc

Perfil proteômico hipocampal em epilepsia do lobo temporal

In this study we used proteomics approaches to obtain the protein profile of human epileptic hippocampi (N=6) and control hippocampi obtained from autopsy (N=6). We used two-dimensional gel electrophoresis (2-D) coupled to HPLC and Mass spectroscopy (MALDI-TOF) to identify proteins differentially expressed. Nine proteins were differentially expressed comparing the hippocampus of patients with the hippocampus of control. Proteins that were increased in the hippocampus of patients with TLE were: isoform 1 of serum albumin, HSP 70, dihydropyrimidinase-related protein 2, isoform 1 of myelin basic protein, proton ATPase catalytic subunit A, and dihydrolipoyllysine-residue acethyltransferase component of pyruvate dehydrogenase complex. The expression of isoform 3 of spectrin alpha chain (fodrin) was down-regulated while the proteins glutathione S-transferase P and the DJ-1 (PARK7) were detected only in the hippocampus of patients with TLE. Taken together, our results provide evidence supporting a direct link between metabolic disturb and oxidative damage related to pathophysiology of TLE. Besides, indicates biomarkers for further investigations as therapies targeted to epilepsy.No presente estudo empregou-se o método de proteômica para obter a expressão diferencial de proteínas em hipocampo de pacientes com epilepsia do lobo temporal (ELT) (N=6) comparado a hipocampos controle obtidos por meio de autópsia (N=6). O estudo foi feito por meio de eletroforese bidimensional, acoplada a HPLC e espectroscopia de massa. As proteínas que tiveram expressão aumentada no hipocampo de pacientes com ELT foram: isoforma-1 da soroalbumina, HSP70, diidropirimidinase-2, isoforma-1 da proteína básica da mielina, subunidade catalítica A da próton ATPase, glutationa S-transferase P, proteína DJ-1 (PARK7), e resíduo diidropolilisina do componente acetil-transferase do complexo da piruvato desidrogenase. A expressão da isoforma-3 da cadeia alfa da espectrina (fodrina) foi menor no hipocampo de pacientes com epilepsia do lobo temporal e as proteínas glutationa S-transferase P e PARK7 foram detectadas somente no tecido epiléptico. Assim, nossos resultados trazem evidencias sobre a direta relação entre distúrbio metabólico e dano oxidativo na patofisiologia da ELT. Além disto, o estudo indica biomarcadores para futuras investigações como alvos terapêuticos para epilepsia.UNIFESP Departamento de Neurologia e NeurocirurgiaUNIFESP Departamento de Microbiologia, Imunologia e ParasitologiaFaculdade de Medicina da Universidade de São Paulo Instituto do Coração Departamento de Anatomia PatológicaUNIFESP, Depto. de Neurologia e NeurocirurgiaUNIFESP, Depto. de Microbiologia, Imunologia e ParasitologiaSciEL

Auras in temporal lobe epilepsy with hippocampal sclerosis: Relation to seizure focus laterality and post surgical outcome

We examined the relationship between presence and frequency of different types of auras and side of lesion and post surgical outcomes in 205 patients with medically intractable mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal sclerosis (HS). With respect to the number of auras, multiple auras were not associated with side of lesion (p=0.551). the side of HS was not associated with the type of auras reported. One hundred fifty-seven patients were operated. the occurrence of multiple auras was not associated with post-surgical outcome (p=0.740). the presence of extratemporal auras was significantly higher in patients with poor outcome. in conclusion, this study suggests that the presence of extratemporal auras in patients with MTLE-HS possibly reflects extratemporal epileptogenicity in these patients, who otherwise showed features suggestive of TLE. Therefore, TLE-HS patients undergoing pre-surgical evaluation and presenting clinical symptoms suggestive of extratemporal involvement should bemore extensively evaluated to avoid incomplete resection of the epileptogenic zone. (C) 2012 Elsevier Inc. All rights reserved.Universidade Federal de São Paulo, Dept Neurol & Neurocirurgia, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Diagnost Imagem, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurocirurgia, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Diagnost Imagem, BR-04024002 São Paulo, BrazilWeb of Scienc

Granule cell dispersion is associated with memory impairment in right mesial temporal lobe epilepsy

Purpose: We analyzed the association of granule cell dispersion (GCD) with memory performance, clinical data and surgical outcome in a series of patients with mesial temporal lobe epilepsy (MILE) and mesial temporal sclerosis (MTS).Method: Hippocampal specimens from 54 patients with MTLE (27 patients with right MILE and 27 with left MTLE) and unilateral MTS, who were separated into CCD and no-GCD groups and thirteen controls were studied. Quantitative neuropathological evaluation was performed using hippocampal sections stained with NeuN. Patients' neuropsychological measures, clinical data, type of MTS and surgical outcome were reviewed.Results: CCD occurred in 28 (51.9%) patients. No correlation between GCD and MTS pattern, clinical data or surgical outcome was found. the presence of GCD was correlated with worse visuospatial memory performance in right MTLE, but not with memory performance in left MTLE.Conclusion: GCD may be related to memory impairment in right MTLE-MTS patients. However, the role of GCD in memory function is not precisely defined. (c) 2012 British Epilepsy Association. Published by Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Instituto Nacional de Neurociencia Translacional (INNT), BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Escola Paulista Med, Unidade Pesquisa & Tratamento Epilepsias, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Escola Paulista Med, BR-04024002 São Paulo, BrazilSanta Casa São Paulo, Dept Pathol, São Paulo, BrazilAFIP, Dept Pathol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosci, Escola Paulista Med, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosurg, Escola Paulista Med, Unidade Pesquisa & Tratamento Epilepsias, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, Escola Paulista Med, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Neurol & Neurosci, Escola Paulista Med, BR-04024002 São Paulo, BrazilWeb of Scienc