2017•New England Journal of MedicineOpen access
Histopathological Findings in Brain Tissue Obtained during Epilepsy Surgery
Ingmar Blümcke, Roberto Spreafico, Gerrit Haaker, Roland Coras, Katja Kobow, Christian G. Bien, Margarete Pfäfflin, Christian Erich Elger, Guido Widman, Johannes Schramm, Albert Johann Becker, Kees P. J. Braun, Frans S. S. Leijten, Johannes C. Baayen, Eleonora Aronica, Francine Chassoux, Hajo M. Hamer, Hermann Stefan, Karl Rössler, Maria Thom, Matthew C. Walker, Sanjay M. Sisodiya, John S. Duncan, Andrew W. McEvoy, Tom Pieper, Hans Holthausen, Manfred Kudernatsch, H. J. Meencke, Philippe Kahane, Andreas Schulze‐Bonhage, Josef Zentner, Dieter Henrik Heiland, Horst Urbach, Bernhard Jochen Steinhoff, Thomas Bast, Laura Tassi, Giorgio Lo Russo, Çiğdem Özkara, Büğe Öz, Pavel Kršek, Silke Vogelgesang, Uwe Runge, Holger Lerche, Yvonne G. Weber, Mrinalini Honavar, José Pimentel, Alexis A. Arzimanoglou, Adriana Ulate-Campos, Soheyl Noachtar, Elisabeth Härtl, Olaf E. M. G. Schijns, Renzo Guerrini, Carmen Barba, Thomas S. Jacques, Judith Helen Cross, Martha Feucht, Angelika Mühlebner, Thomas Grünwald, Eugen Trinka, Peter Winkler, António Gil‐Nagel, Rafael Toledano, Thomas Mayer, Martin Lutz, Basilios Zountsas, Kyriakos Garganis, Felix Rosenow, Anke Hermsen, Tim J. von Oertzen, Thomas Ludwig Diepgen, GIULIANO AVANZINI
Abstract
BACKGROUND: Detailed neuropathological information on the structural brain lesions underlying seizures is valuable for understanding drug-resistant focal epilepsy. METHODS: We report the diagnoses made on the basis of resected brain specimens from 9523 patients who underwent epilepsy surgery for drug-resistant seizures in 36 centers from 12 European countries over 25 years. Histopathological diagnoses were determined through examination of the specimens in local hospitals (41%) or at the German Neuropathology Reference Center for Epilepsy Surgery (59%). RESULTS: The onset of seizures occurred before 18 years of age in 75.9% of patients overall, and 72.5% of the patients underwent surgery as adults. The mean duration of epilepsy before surgical resection was 20.1 years among adults and 5.3 years among children. The temporal lobe was involved in 71.9% of operations. There were 36 histopathological diagnoses in seven major disease categories. The most common categories were hippocampal sclerosis, found in 36.4% of the patients (88.7% of cases were in adults), tumors (mainly ganglioglioma) in 23.6%, and malformations of cortical development in 19.8% (focal cortical dysplasia was the most common type, 52.7% of cases of which were in children). No histopathological diagnosis could be established for 7.7% of the patients. CONCLUSIONS: In patients with drug-resistant focal epilepsy requiring surgery, hippocampal sclerosis was the most common histopathological diagnosis among adults, and focal cortical dysplasia was the most common diagnosis among children. Tumors were the second most common lesion in both groups. (Funded by the European Union and others.).