Mathern G W, Pretorius J K, Babb T L
Department of Neurology, University of California at Los Angeles School of Medicine.
J Neurosurg. 1995 Feb;82(2):211-9. doi: 10.3171/jns.1995.82.2.0211.
Quantified hippocampal mossy fiber synaptic reorganization and neuron losses were measured to determine the pathological features associated with epileptogenic fascia dentata. Twenty-five patients with temporal lobe epilepsy (TLE) were classified as having either mesial temporal sclerosis (MTS; 16 patients), with seizure genesis in the hippocampus, or temporal mass lesions (nine patients), with seizures that were probably extrahippocampal. Neo-Timm's histochemistry identified mossy fiber sprouting, and aberrant fascia dentata puncta densities were objectively measured by light microscopic analysis on an image-analysis computer. neuron densities determined cell losses and the two seizure groups were compared to control specimens obtained from autopsies. Results showed significantly greater fascia dentata mossy fiber puncta densities and neuron losses in TLE patients compared to autopsy specimens (p < 0.026). Furthermore, there were significant differences between the two seizure groups: 1) mossy fiber puncta densities in the inner molecular layer were significantly greater in MTS compared to lesions (p < 0.02), and 2) mossy fiber puncta densities were greater in the inner molecular layer than in the stratum granulosum in 14 of 16 MTS patients (88%) compared to four of nine patients with lesions (44%, p < 0.01). Neuron densities were significantly different comparing MTS, lesion and control groups for stratum granulosum (p = 0.0001) and Ammon's horn (p = 0.0001), with each group significantly different (p < 0.05) compared to another. All patients were either seizure-free or significantly improved 1 year or more after en bloc temporal lobectomy. There were no significant correlations between fascia dentata mossy fiber puncta densities and counts of hilar neurons, CA4 pyramids, granule cells, or years of seizures. This indicates that inner molecular layer mossy fiber puncta densities and neuron losses are greater in patients with MTS than in those with lesions, and mossy fiber sprouting probably contributes to the pathophysiology of hippocampal seizures. Furthermore, these data show that some patients with extrahippocampal lesions have mossy fiber sprouting similar to MTS patients, suggesting that hippocampi in lesion patients may be capable of epileptogenesis from synaptic reorganization.
测量海马苔藓纤维突触重组和神经元损失的量化情况，以确定与致痫性齿状回相关的病理特征。25例颞叶癫痫（TLE）患者被分为两组：海马硬化（MTS；16例），癫痫起源于海马；颞叶占位性病变（9例），癫痫可能起源于海马外。采用改良的Timm组织化学方法鉴定苔藓纤维发芽，并通过图像分析计算机上的光学显微镜分析客观测量异常齿状回点密度。神经元密度确定细胞损失情况，并将两个癫痫组与尸检获得的对照标本进行比较。结果显示，与尸检标本相比，TLE患者的齿状回苔藓纤维点密度和神经元损失显著更大（p < 0.026）。此外，两个癫痫组之间存在显著差异：1）MTS组内分子层的苔藓纤维点密度显著高于病变组（p < 0.02）；2）16例MTS患者中有14例（88%）内分子层的苔藓纤维点密度高于颗粒层，而9例病变患者中有4例（44%）如此，差异有统计学意义（p < 0.01）。颗粒层（p = 0.0001）和海马角（p = 0.0001）的神经元密度在MTS组、病变组和对照组之间存在显著差异，每组之间相比差异均有统计学意义（p < 0.05）。所有患者在整块颞叶切除术后1年或更长时间均无癫痫发作或显著改善。齿状回苔藓纤维点密度与海马神经元、CA4锥体神经元、颗粒细胞数量或癫痫发作年限之间无显著相关性。这表明MTS患者内分子层苔藓纤维点密度和神经元损失比病变患者更大，苔藓纤维发芽可能促成了海马癫痫的病理生理过程。此外，这些数据表明，一些海马外病变患者的苔藓纤维发芽与MTS患者相似，提示病变患者的海马可能能够通过突触重组发生癫痫。
