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57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

German Society for Neuropathology and Neuroanatomy

12. - 15.09.2012, Erlangen

57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

Blurring in temporal lobe epilepsy patients: clinical, radiological and ultrastructural study

Meeting Abstract

  • presenting/speaker Francesco Deleo - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Rita Garbelli - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Gloria Milesi - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Valentina Medici - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Flavio Villani - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Giuseppe Didato - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Ludovico D'Incerti - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Michela Morbin - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Giulia Mazzoleni - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Anna Rita Giovagnoli - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Annalisa Parente - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Ileana Zucca - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Alfonso Mastropietro - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy
  • Roberto Spreafico - Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milano, Italy

Deutsche Gesellschaft für Neuropathologie und Neuroanatomie. 57th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN). Erlangen, 12.-15.09.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgnnPP6.9

DOI: 10.3205/12dgnn120, URN: urn:nbn:de:0183-12dgnn1200

Published: September 11, 2012

© 2012 Deleo et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Magnetic Resonance Imaging (MRI)-positive temporal lobe atrophy with temporo-polar grey/white matter abnormalities (“blurring”) has been frequently reported in patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS), but there is no consensus regarding its genesis.

The aim of this study was to investigate the pathological substrate of temporo-polar blurring. The study involved 32 consecutive patients with medically intractable TLE and HS who underwent surgery. They were divided into two groups on the basis of the presence/absence of temporopolar blurring. Surgical specimens were examined neuropathologically and selected samples from both groups underwent high-field 7T MRI and ultrastructural studies. At clinical level an earlier age at epilepsy onset and a longer duration of epilepsy was found in the patients with blurring. Blurring was also associated with lower neuropsychological test scores, with a significant relationship to abstract reasoning.

7T MRI examination showed only in those patients with blurring a dishomogeneous signal in the white matter, with patchy areas of hyperintensity. Sections from the patients with blurring that were processed for myelin staining revealed dishomogeneous staining of the white matter, which was confirmed by analyses of the corresponding semi-thin sections.

Ultrastructural examinations revealed the presence of axonal degeneration and a significant reduction in the number of axons in the patients with blurring.

These data provide robust evidence that temporo-polar blurring is caused by the degeneration of fibre bundles, and suggest slowly evolving chronic degeneration with the redistribution of the remaining fibres.


References

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Mitchell LA, Harvey AS, Coleman LT, Mandelstam SA, Jackson GD. Anterior temporal changes on MR images of children with hippocampal sclerosis: An effect of seizures on the immature brain? Am J Neuroradiol. 2003;24:1670-7.
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Schijns OE, Bien CG, Majores r M, von Lehe M, Urbach H, Becker A, et al. Presence of temporalgray-white matter abnormalities does not influence P epilepsy surgery outcome in temporal lobe epilepsy with hippocampal sclerosis. Neurosurgery. 2011; 68: 98,106; discussion 107.