Advertisement

Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis

  • Jafar Mehvari Habibabadi
  • Shervin Badihian
  • Nasim Tabrizi
  • Navid Manouchehri
  • Mohammad Zare
  • Reza Basiratnia
  • Majid Barekatain
  • Houshang Moein
  • Amirali Mehvari Habibabadi
  • Payam Moein
  • Peyman GookizadehEmail author
Original Article
  • 42 Downloads

Abstract

Purpose

Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS.

Methods

This is a cross-sectional study conducted during 2007–2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS.

Results

Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (P value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (P > 0.05).

Conclusions

We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.

Keywords

Hippocampal sclerosis Dual pathology Drug-resistant epilepsy Mesial temporal sclerosis 

Notes

Funding

We wish to thank vice-chancellor for research and technology of Isfahan University of Medical Sciences for supporting and funding this project (grant number 394004).

References

  1. 1.
    Thurman DJ, Beghi E, Begley CE, Berg AT, Buchhalter JR, Ding D, Hesdorffer DC, Hauser WA, Kazis L, Kobau R (2011) Standards for epidemiologic studies and surveillance of epilepsy. Epilepsia 52(s7):2–26PubMedCrossRefGoogle Scholar
  2. 2.
    Kwan P, Brodie MJ (2000) Early identification of refractory epilepsy. N Engl J Med 342(5):314–319PubMedCrossRefGoogle Scholar
  3. 3.
    Semah F, Lamy C, Demeret S, Dlugos DJ (2002) Hippocampal sclerosis and other hippocampal abnormalities in the early identification of candidates for epilepsy surgery. Arch Neurol 59(6):1042–3; author reply 1043PubMedCrossRefGoogle Scholar
  4. 4.
    Bouchet C, Cazauvieilh J (1825) De l’épilepsie considérée dans ses rapports avec l’aliénation mentale. Arch Gen Med 9:510–542Google Scholar
  5. 5.
    Kim DW, Lee SK, Nam H, Chu K, Chung CK, Lee SY, Choe G, Kim HK (2010) Epilepsy with dual pathology: surgical treatment of cortical dysplasia accompanied by hippocampal sclerosis. Epilepsia 51(8):1429–1435PubMedCrossRefGoogle Scholar
  6. 6.
    Téllez-Zenteno JF, Hernández-Ronquillo L (2011) A review of the epidemiology of temporal lobe epilepsy. Epilepsy Res Treat 2012Google Scholar
  7. 7.
    Wiebe S (2000) Epidemiology of temporal lobe epilepsy. Can J Neurol Sci 27(S1):S6–S10PubMedCrossRefGoogle Scholar
  8. 8.
    Vickrey B, Rausch R, Engel J, Ary C, Visscher B, Hays R, Brook R, Rogers W (1995) Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery. Lancet 346(8988):1445–1449PubMedCrossRefGoogle Scholar
  9. 9.
    Kuzniecky RI, Knowlton RC Neuroimaging of epilepsy. In: Semin Neurol, 2002. vol 03. Copyright© 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.:+ 1 (212) 584–4662, pp 279–288Google Scholar
  10. 10.
    Lévesque MF, Nakasato N, Vinters HV, Babb TL (1991) Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg 75(3):364–370PubMedCrossRefGoogle Scholar
  11. 11.
    Wyllie E, Cascino GD, Gidal BE, Goodkin HP (2012) Wyllie's treatment of epilepsy: principles and practice. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  12. 12.
    Kutsy RL (1999) Focal extratemporal epilepsy: clinical features, EEG patterns, and surgical approach. J Neurol Sci 166(1):1–15PubMedCrossRefGoogle Scholar
  13. 13.
    Li L, Cendes F, Andermann F, Watson C, Fish D, Cook M, Dubeau F, Duncan J, Shorvon S, Berkovic S (1999) Surgical outcome in patients with epilepsy and dual pathology. Brain 122(5):799–805PubMedCrossRefGoogle Scholar
  14. 14.
    Luders HO (2008) Textbook of epilepsy surgery. CRC Press, Boca RatonCrossRefGoogle Scholar
  15. 15.
    Salanova V, Markand O, Worth R (2004) Temporal lobe epilepsy: analysis of patients with dual pathology. Acta Neurol Scand 109(2):126–131PubMedCrossRefGoogle Scholar
  16. 16.
    Eriksson S, Nordborg C, Rydenhag B, Malmgren K (2005) Parenchymal lesions in pharmacoresistant temporal lobe epilepsy: dual and multiple pathology. Acta Neurol Scand 112(3):151–156PubMedCrossRefGoogle Scholar
  17. 17.
    Kwan P, Arzimanoglou A, Berg AT, Brodie MJ, Allen Hauser W, Mathern G, Moshé SL, Perucca E, Wiebe S, French J (2010) Definition of drug resistant epilepsy: consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia 51(6):1069–1077PubMedCrossRefGoogle Scholar
  18. 18.
    Colombo N, Salamon N, Raybaud C, Özkara Ç, Barkovich AJ (2009) Imaging of malformations of cortical development. Epileptic Disorders 11(3):194–205PubMedGoogle Scholar
  19. 19.
    Arora V, Nijjar I, Mahajan D, Sandhu P, Singh J, Chopra R (2005) MRI in seizure disorder-a pictorial essay. Ind J Radiol Imaging 15(3):331CrossRefGoogle Scholar
  20. 20.
    Cendes F, Theodore WH, Brinkmann BH, Sulc V, Cascino GD (2016) Neuroimaging of epilepsy. In: Handbook of clinical neurology, vol 136. Elsevier, pp 985–1014Google Scholar
  21. 21.
    De Lanerolle NC, Kim JH, Williamson A, Spencer SS, Zaveri HP, Eid T, Spencer DD (2003) A retrospective analysis of hippocampal pathology in human temporal lobe epilepsy: evidence for distinctive patient subcategories. Epilepsia 44(5):677–687PubMedCrossRefGoogle Scholar
  22. 22.
    Cendes F, Cook M, Watson C, Andermann F, Fish D, Shorvon S, Bergin P, Free S, Dubeau F, Arnold D (1995) Frequency and characteristics of dual pathology in patients with lesional epilepsy. Neurology 45(11):2058–2064PubMedCrossRefGoogle Scholar
  23. 23.
    Pasquier B, Péoc'H M, Fabre-Bocquentin B, Bensaadi L, Pasquier D, Hoffmann D, Kahane P, Tassi L, Le Bas J-F, Benabid AL (2002) Surgical pathology of drug-resistant partial epilepsy. A 10-year-experience with a series of 327 consecutive resections. Epileptic Disord 4(2):99–119PubMedGoogle Scholar
  24. 24.
    Jay V, Becker LE (1994) Surgical pathology of epilepsy: a review. Pediatr Pathol 14(4):731–750PubMedCrossRefGoogle Scholar
  25. 25.
    Rougier A (2008) Dual pathology. Neuro-Chirurgie 54(3):382–387PubMedCrossRefGoogle Scholar
  26. 26.
    Thom M, Sisodiya S, Harkness W, Scaravilli F (2001) Microdysgenesis in temporal lobe epilepsy. Brain 124(11):2299–2309PubMedCrossRefGoogle Scholar
  27. 27.
    Moosa AN, Gupta A (2014) Outcome after epilepsy surgery for cortical dysplasia in children. Childs Nerv Syst 30(11):1905–1911PubMedCrossRefGoogle Scholar
  28. 28.
    Kuzniecky RI, Barkovich AJ (1996) Pathogenesis and pathology of focal malformations of cortical development and epilepsy. J Clin Neurophysiol 13(6):468–480PubMedCrossRefGoogle Scholar
  29. 29.
    Aghakhani N, Azami M, Jasemi M, Khoshsima M, Eghtedar S, Rahbar N (2013) Epidemiology of traumatic brain injury in urmia, Iran. Iran Red Crescent Med J 15(2):173–174PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Foit NA, van Velthoven V, Schulz R, Blümcke I, Urbach H, Woermann FG, Bien CG (2017) Lesional cerebellar epilepsy: a review of the evidence. J Neurol 264(1):1–10PubMedCrossRefGoogle Scholar
  31. 31.
    Crooks R, Mitchell T, Thom M (2000) Patterns of cerebellar atrophy in patients with chronic epilepsy: a quantitative neuropathological study. Epilepsy Res 41(1):63–73PubMedCrossRefGoogle Scholar
  32. 32.
    Bocti C, Robitaille Y, Diadori P, Lortie A, Mercier C, Bouthillier A, Carmant L (2003) The pathological basis of temporal lobe epilepsy in childhood. Neurology 60(2):191–195PubMedCrossRefGoogle Scholar
  33. 33.
    Caciagli L, Bernasconi A, Wiebe S, Koepp MJ, Bernasconi N, Bernhardt BC (2017) A meta-analysis on progressive atrophy in intractable temporal lobe epilepsy: time is brain? Neurology 89(5):506–516PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2018

Authors and Affiliations

  • Jafar Mehvari Habibabadi
    • 1
  • Shervin Badihian
    • 1
    • 2
  • Nasim Tabrizi
    • 3
  • Navid Manouchehri
    • 1
    • 2
  • Mohammad Zare
    • 1
  • Reza Basiratnia
    • 1
  • Majid Barekatain
    • 1
  • Houshang Moein
    • 1
  • Amirali Mehvari Habibabadi
    • 1
  • Payam Moein
    • 4
  • Peyman Gookizadeh
    • 1
    • 2
    • 5
    Email author
  1. 1.Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
  2. 2.Students’ Research Center, School of MedicineIsfahan University of Medical SciencesIsfahanIran
  3. 3.Neurology Department, Medical SchoolMazandaran University of Medical SciencesSariIran
  4. 4.Department of NeurologyUniversity of Tennessee Health Science CenterMemphisUSA
  5. 5.IsfahanIran

Personalised recommendations