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癫痫患者沿海马纵轴的硬化变异性:一项尸体研究。

Variability of sclerosis along the longitudinal hippocampal axis in epilepsy: a post mortem study.

机构信息

Department of Clinical and Experimental Epilepsy, UK.

出版信息

Epilepsy Res. 2012 Nov;102(1-2):45-59. doi: 10.1016/j.eplepsyres.2012.04.015. Epub 2012 May 16.

Abstract

Detailed neuropathological studies of the extent of hippocampal sclerosis (HS) in epilepsy along the longitudinal axis of the hippocampus are lacking. Neuroimaging studies of patients with temporal lobe epilepsy support that sclerosis is not always localised. The extent of HS is of relevance to surgical planning and poor outcomes may relate to residual HS in the posterior remnant. In 10 post mortems from patients with long histories of drug refractory epilepsy and 3 controls we systematically sampled the left and right hippocampus at seven coronal anatomical levels along the body to the tail. We quantified neuronal densities in CA1 and CA4 subfields at each level using Cresyl Violet (CV), calretinin (CR), calbindin (CB) and Neuropeptide Y (NPY) immunohistochemistry. In the dentate gyrus we graded the extent of granule cell dispersion, patterns of CB expression, and synaptic reorganisation with CR and NPY at each level. We identified four patterns of HS based on patterns of pyramidal and interneuronal loss and dentate gyrus reorganisation between sides and levels as follows: (1) symmetrical HS with anterior-posterior (AP) gradient, (2) symmetrical HS without AP gradient, (3) asymmetrical HS with AP gradient and (4) asymmetrical cases without AP gradient. We confirmed in this series that HS can extend into the tail. The patterns of sclerosis (classical versus atypical or none) were consistent between all levels in less than a third of cases. In conclusion, this series highlights the variability of HS along the longitudinal axis. Further studies are required to identify factors that lead to focal versus diffuse HS.

摘要

详细的神经病理学研究表明,海马硬化(HS)在癫痫患者的海马体纵轴上的程度存在差异。颞叶癫痫患者的神经影像学研究支持硬化并不总是局限的。HS 的程度与手术计划有关,不良预后可能与后残余物中的残余 HS 有关。在 10 例有长期药物难治性癫痫病史的尸检和 3 例对照中,我们系统地在七个冠状解剖水平对左、右海马体进行采样,从体部到尾部。我们使用 Cresyl Violet(CV)、钙视网膜蛋白(CR)、钙结合蛋白(CB)和神经肽 Y(NPY)免疫组织化学,在每个水平量化 CA1 和 CA4 亚区的神经元密度。在齿状回中,我们在每个水平上根据颗粒细胞弥散、CB 表达模式和 CR 和 NPY 的突触重组程度对齿状回的程度进行分级。我们根据两侧和水平之间的锥体细胞和中间神经元丢失以及齿状回重组的模式,确定了四种 HS 模式,如下所示:(1)有前后(AP)梯度的对称 HS,(2)无 AP 梯度的对称 HS,(3)有 AP 梯度的不对称 HS 和(4)无 AP 梯度的不对称病例。我们在本系列中证实 HS 可以延伸到尾部。在不到三分之一的病例中,硬化模式(经典与非典型或无)在所有水平上都是一致的。总之,本系列强调了 HS 在纵轴上的可变性。需要进一步研究来确定导致局灶性与弥漫性 HS 的因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edea/3500681/64d534b1c3d6/gr1.jpg

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