Corpora amylacea in mesial temporal lobe epilepsy: clinico-pathological correlations.
OBJECTIVE
To investigate the electro-clinical significance of premature accumulation of corpora amylacea (CoA) in the resected hippocampus of patients with medically refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS).


METHODS
We compared the clinical and EEG characteristics, and post-operative seizure outcome of 373 (mean age 29.4 years, range 7-55 years) surgically treated MTLE-HS patients with (MTLE-HS-CoA(+), n=129 [34.5%]) and without (MTLE-HS-CoA(-), n=244 [65.5%]) CoA.


RESULTS
Age at surgery was significantly higher and duration of epilepsy before surgery was significantly longer for MTLE-HS-CoA(+) patients compared to MTLE-HS-CoA(-) patients. Although the distribution of interictal epileptiform EEG abnormalities did not differ, type 1 ictal EEG pattern was more frequent in MTLE-HS-CoA(+) patients. Among the 21 patients with major interictal psychosis detected prior to epilepsy surgery, 19 (90.5%) belonged to MTLE-HS-CoA(+) group. Schizophrenia-like psychosis was most prevalent. The post-operative seizure-free outcome was comparable, but significantly more MTLE-HS-CoA(-) patients were free of antiepileptic drugs.


CONCLUSIONS
Overall, our observations support the hypothesis that the pathological process in MTLE-HS is progressive. MTLE-HS-CoA(+) patients are predisposed to increased psychiatric morbidity. In vivo detection of hippocampal CoA accumulation in the future will help us to understand the neurobiological significance of this phenomenon.
Radhakrishnan
Ashalatha
A
R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
Radhakrishnan
Kurupath
K
Radhakrishnan
Venkataraman V
VV
Mary
Paramban R
PR
Kesavadas
Chandrasekharan
C
Alexander
Aley
A
Sarma
P Sankara
PS
D000293:Adolescent; D000328:Adult; D002648:Child; D003937:Diagnosis, Differential; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000473:pathology* / Q000523:psychology / Q000601:surgery; D005260:Female; D006624:Hippocampus / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000209:etiology / Q000523:psychology; D012189:Retrospective Studies; D012598:Sclerosis; D012640:Seizures / Q000453:epidemiology / Q000601:surgery; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome