Sitovskaya D A, Zabrodskaya Yu M, Sokolova T V, Kuralbaev A K, Nezdorovina V G, Dobrogorskaya L N
Prof. A.L. Polenov Russian Research Institute of Neurosurgery Branch of the V.A. Almazov National Medical Research Center of the Ministry of Health of Russia, St. Petersburg, Russia.
Saint Petersburg State Pediatric Medical University, St. Petersburg, Russia.
Arkh Patol. 2020;82(6):5-15. doi: 10.17116/patol2020820615.
To study etiopathogenesis is one of the most important tasks of modern neurology. Various types of structural changes occur in drug-resistant epilepsy (DRE); however, they are described as distinct phenomena.
To provide a comprehensive characterization of structural changes in the cortex and adjacent white matter in the electrophysiological activity zone (in the epileptic focus) in patients undergoing surgery for DRE.
Biopsy material of fragments of the temporal lobe and hippocampus from 16 patients aged 21 to 54 years (mean age, 25 years) with DRE were intraoperatively obtained at the Prof. A.L. Polenov Russian Research Institute of Neurosurgery. The investigators studied histological sections stained with H&E, toluidine blue according to the Nissl method and the Spielmeyer method, as well as the results of immunohistochemical reactions with glial fibrillary acidic protein (GFAP), vimentin, and neurofilaments (NF) (Dako antibodies, Denmark).
Histological examination revealed a set of heterogeneous changes, reflecting the complex pathogenetic interactions that developed during the formation of an epileptic focus. Structural brain damage involved both gray and white matter. Focal cortical dysplasia was diagnosed in 14 (87.5%) cases; white matter neuronal heterotopia in 100%; neuronal reactive and destructive changes in 100%; epileptic leukoencephalopathy (vascular demyelination, microcysts, sclerosis and dystonia, gliosis) in 100%, cortical atrophy in 12.5%, and hippocampal sclerosis in 20% (in 2 out of the 10 examinees).
The morphopathological heterogeneity in the structure of epileptic foci reflects the complexity of etiopathogenetic interactions, the polymorphism of epileptic manifestations, and the individual nature of formation of the epileptic system, which requires an integral approach to understanding the pathogenesis and morphogenesis of formation of the epileptic system and provides a direction for a personalized approach to epilepsy treatment.
研究病因发病机制是现代神经病学最重要的任务之一。耐药性癫痫（DRE）会出现各种类型的结构变化；然而，它们被描述为不同的现象。
全面描述接受DRE手术患者电生理活动区（癫痫病灶）皮质及相邻白质的结构变化。
在俄罗斯神经外科研究所A.L. 波列诺夫教授处，术中获取了16例年龄在21至54岁（平均年龄25岁）的DRE患者颞叶和海马体碎片的活检材料。研究人员对苏木精-伊红染色、根据尼氏法和施皮尔曼法进行的甲苯胺蓝染色的组织切片，以及胶质纤维酸性蛋白（GFAP）、波形蛋白和神经丝（NF）免疫组化反应结果（丹麦达科抗体）进行了研究。
组织学检查发现一系列异质性变化，反映了癫痫病灶形成过程中发生的复杂致病相互作用。脑结构损伤累及灰质和白质。14例（87.5%）诊断为局灶性皮质发育异常；100%存在白质神经元异位；100%存在神经元反应性和破坏性变化；100%存在癫痫性白质脑病（血管性脱髓鞘、微囊肿、硬化和肌张力障碍、胶质增生），12.5%存在皮质萎缩，20%（10例受检者中有2例）存在海马硬化。
癫痫病灶结构的形态病理学异质性反映了病因发病机制相互作用的复杂性、癫痫表现的多态性以及癫痫系统形成的个体性，这需要采用整体方法来理解癫痫系统形成的发病机制和形态发生，并为癫痫治疗的个性化方法提供了方向。
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