Kasper B S, Stefan H, Buchfelder M, Paulus W
Department of Neuropathology, University of Erlangen, Germany.
J Neuropathol Exp Neurol. 1999 Jan;58(1):22-8. doi: 10.1097/00005072-199901000-00003.
Histopathologic evaluation of brain tissue derived from surgically treated patients with medically refractory temporal lobe epilepsy (TLE) frequently reveals structural brain lesions in the surgical specimen. While several of the most commonly encountered lesions such as low-grade neoplasms or vascular malformations are well established as structural substrates of epilepsy, the significance of subtle microscopic characteristics has remained controversial. Within the spectrum a broad range of microscopic features has previously been reported as "mild cortical dysplasia," "focal cortical dysplasia," or "microdysgenesis," including cortical laminar disorganization, columnar arrangement of cortical neurons, marked clustering of neurons throughout cortical layers II-VI, increased numbers of molecular layer neurons, marked perivascular clustering of oligodendroglia in the white matter, single heterotopic neurons in the deep white matter, glioneuronal hamartia, giant neurons, and balloon cell change. In this paper we report the frequency of these features in temporal lobe tissue of 47 surgically treated TLE-patients vs 29 normal autopsy controls. While most of them were found in both cases and controls, clustering of neurons throughout cortical layers II-VI, perivascular clustering of oligodendroglia in the white matter, increased single heterotopic white matter neurons, and glioneuronal hamartias predominated in tissue from patients with epilepsy (p < 0.05). A count of more than 10 white matter neurons/HPF was associated with a worse postoperative outcome (p < 0.05). These data suggest that certain microscopic characteristics are associated with the epileptic process, while others appear as normal variants.
对接受手术治疗的药物难治性颞叶癫痫（TLE）患者的脑组织进行组织病理学评估时，手术标本中常发现脑部存在结构性病变。虽然一些最常见的病变，如低度肿瘤或血管畸形，已被确认为癫痫的结构性基础，但细微微观特征的意义仍存在争议。在这一范围内，此前已有广泛的微观特征被报道为“轻度皮质发育异常”“局灶性皮质发育异常”或“微发育异常”，包括皮质层状结构紊乱、皮质神经元柱状排列、皮质II - VI层神经元明显聚集、分子层神经元数量增加、白质中少突胶质细胞明显的血管周围聚集、深部白质中的单个异位神经元、神经胶质神经元错构瘤、巨型神经元以及气球样细胞改变。在本文中，我们报告了47例接受手术治疗的TLE患者与29例正常尸检对照的颞叶组织中这些特征的出现频率。虽然大多数特征在病例组和对照组中均有发现，但皮质II - VI层神经元聚集、白质中少突胶质细胞血管周围聚集、单个异位白质神经元数量增加以及神经胶质神经元错构瘤在癫痫患者组织中更为常见（p < 0.05）。每高倍视野白质神经元计数超过10个与术后预后较差相关（p < 0.05）。这些数据表明，某些微观特征与癫痫过程相关，而其他一些则似乎是正常变异。
