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Neuropathological findings in 224 patients with temporal lobe epilepsy

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Abstract

During the period between 1976 and 1990, 247 patients with pharmaco-resistant complex partial seizures and a documented unilateral epileptogenic area in the mediobasal temporal lobe underwent a selective amygdalo-hippocampectomy procedure at our institution. Biopsy specimens from 224 patients (91% of the total) were available for a retrospective histopathological and immunohistochemical review. The tissue specimens of 23 patients without evidence for a macroscopic lesion have been used for neurochemical studies and could not be evaluated histopathologically. The most common temporal lobe pathology were neoplasms in 126 patients, i.e. 56%. Tumor entities observed included 23 astrocytomas (18% of all tumors), 17 gangliogliomas (13%), 15 oligodendrogliomas (12%), 15 cases of glioblastoma multiforme (12%), 13 pilocytic astrocytomas (10%), 12 oligo-astrocytomas (10%), 11 anaplastic astrocytomas (9%) and 20 tumors of various other histologies. In 23 specimens (10%), small foci of oligodendroglia-like clear cells were found. The frequent association of these foci with low-grade gliomas or neural hamartomas raises the possibility that these structures may serve as precursor lesion for neuroepithelial tumors of the temporal lobe. In 98 cases, pathological changes of non-neoplastic origin were encountered. The most common diagnoses in this group included hippocampal gliosis/sclerosis (49 cases, 22%) and vascular malformations (20 cases, 9%). Hamartomas, i.e. focal accumulations of dysplastic neuro-glial cells were diagnosed in 14 patients (6%). In only four cases have we not been able to detect any microscopic pathology. These results indicate that a high proportion of pharmaco-therapy-resistent complex-partial seizures are caused by neoplasms of the temporal lobe, some of which appear to the strikingly overrepresented in this group of patients.

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Author notes

  1. Karl H. Plate

    Present address: Department of Pathology (Neuropathology), University of Marburg, D-35043, Marburg, Germany

  2. Otmar D. Wiestler

    Present address: Department of Neuropathology, University of Bonn Medical Center, D-53105, Bonn, Germany

Authors and Affiliations

  1. Department of Pathology (Neuropathology), University of Zürich, CH-8091, Zürich, Switzerland

    Karl H. Plate & Otmar D. Wiestler

  2. Departments of Neurology, University of Zürich, CH-8091, Zürich, Switzerland

    Heinz-Gregor Wieser

  3. Department of Neurosurgery, University of Zürich, CH-8091, Zürich, Switzerland

    M. Gazi Yasargil

Authors
  1. Karl H. Plate
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  2. Heinz-Gregor Wieser
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  3. M. Gazi Yasargil
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  4. Otmar D. Wiestler
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Plate, K.H., Wieser, HG., Yasargil, M.G. et al. Neuropathological findings in 224 patients with temporal lobe epilepsy. Acta Neuropathol 86, 433–438 (1993). https://doi.org/10.1007/BF00228577

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  • DOI: https://doi.org/10.1007/BF00228577

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