Duarte Jeana Torres Corso, Jardim Anaclara Prada, Comper Sandra Mara, De Marchi Luciana Rodrigues, Gaça Larissa Botelho, Garcia Maria Teresa Fernandes Castilho, Sandim Gabriel Barbosa, Assunção-Leme Idaiane Batista, Carrete Henrique, Centeno Ricardo Silva, Lancellotti Carmen Lúcia Penteado, Jackowski Andrea P, Cavalheiro Esper Abrão, Guaranha Mirian Salvadori Bittar, Yacubian Elza Márcia Targas
Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650, Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650, Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
Epilepsy Res. 2018 Nov;147:51-57. doi: 10.1016/j.eplepsyres.2018.08.009. Epub 2018 Aug 23.
To evaluate if the duration of epilepsy influences MRI volumes of the hippocampus, amygdala, parahippocampal gyrus, entorhinal cortex and temporal pole of both hemispheres and epileptogenic hippocampus neuronal cell density and dentate gyrus granular cells distribution in patients with refractory mesial temporal lobe epilepsy due to hippocampal sclerosis (MTLE/HS).
Seventy-seven patients with refractory MTLE/HS submitted to surgery were included. Histopathological analysis included: (1) quantitative: hippocampal subfields and total estimated hippocampal cell density (HCD), thickness of the dentate gyrus - normal, thinning or dispersion; (2) qualitative: type of HS and granule cells pathology in the dentate gyrus (normal, neuronal cell loss, dispersion and bilamination). Automated MRI-derived measurements from bilateral temporal structures (hippocampus, amygdala, parahippocampal gyrus, temporal pole, entorhinal cortex) were obtained for 58 subjects. Histopathological and imaging findings were compared with data from specimens obtained in autopsies of age-matched individuals and living controls, respectively, and the data were adjusted for the age at epilepsy onset and the frequency of focal impaired awareness seizures/month.
Forty-two (54.5%) patients presented right HS. The greater the duration of epilepsy, the smaller the total estimated HCD (p = 0.025; r = -0.259). Patients with a normal distribution of the granular cells had a shorter epilepsy duration than those with dispersion (p = 0.018) or thinning (p = 0.031). A reduced ipsilateral hippocampal volume (r = -0.551, p = 0.017) and a smaller hippocampal asymmetry index (r = -0.414, p = 0.002) were correlated to a longer epilepsy duration. The estimated HCD was correlated to the volume of the ipsilateral hippocampus (r = 0.420, p = 0.001).
Our study showed an increasing atrophy of the ipsilateral hippocampus in patients with a longer epilepsy duration. Our data suggest that this reduction in hippocampal volume is related to neuronal loss. Besides that, we also showed an increased probability of exhibiting an abnormal distribution of the granular cells in the dentate gyrus in patients with longer epilepsy duration.
评估癫痫持续时间是否会影响双侧海马、杏仁核、海马旁回、内嗅皮质和颞极的MRI体积，以及海马硬化所致难治性内侧颞叶癫痫（MTLE/HS）患者致痫海马神经元细胞密度和齿状回颗粒细胞分布。
纳入77例接受手术治疗的难治性MTLE/HS患者。组织病理学分析包括：（1）定量分析：海马亚区及总估计海马细胞密度（HCD）、齿状回厚度——正常、变薄或分散；（2）定性分析：HS类型及齿状回颗粒细胞病理学表现（正常、神经元细胞丢失、分散和双分层）。对58例受试者进行了双侧颞叶结构（海马、杏仁核、海马旁回、颞极、内嗅皮质）的自动MRI测量。分别将组织病理学和影像学结果与年龄匹配个体尸检标本及活体对照的数据进行比较，并根据癫痫发作起始年龄和每月局灶性意识障碍发作频率对数据进行调整。
42例（54.5%）患者表现为右侧HS。癫痫持续时间越长，总估计HCD越小（p = 0.025；r = -0.259）。颗粒细胞分布正常的患者癫痫持续时间短于颗粒细胞分散（p = 0.018）或变薄（p = 0.031）的患者。同侧海马体积减小（r = -0.551，p = 0.017）和海马不对称指数减小（r = -0.414，p = 0.002）与癫痫持续时间延长相关。估计的HCD与同侧海马体积相关（r = 0.420，p = 0.001）。
我们的研究表明，癫痫持续时间较长的患者同侧海马萎缩加剧。我们的数据表明，海马体积的减小与神经元丢失有关。除此之外，我们还表明，癫痫持续时间较长的患者齿状回颗粒细胞出现异常分布的可能性增加。
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