title: Association between temporal lobe P-glycoprotein expression and seizure recurrence after surgery for pharmacoresistant temporal lobe epilepsy.
abstract: Surgery is recommended for pharmacoresistant temporal lobe epilepsy (TLE), but seizures recur in approximately one third of patients postsurgery. P-glycoprotein is an efflux multidrug transporter that is overexpressed in a range of epileptogenic pathologies. We hypothesized that increased expression of P-glycoprotein in the epileptogenic temporal lobe might be a marker for recurrence of pharmacoresistant seizures postsurgery. We performed immunohistochemistry on temporal lobe tissues resected from 69 patients who underwent anterior temporal lobectomy for pharmacoresistant TLE with histopathological proven hippocampal sclerosis. P-glycoprotein expression was rated by three pathologists independently. Patients with seizure recurrence (n=22) had greater number of positively stained capillaries (p=0.001) and higher P-glycoprotein immunoreactive score in capillaries (p=0.002) in the white matter of resected temporal lobe. The differences remained significant in multivariate analysis (p=0.002 and 0.006, respectively). The results suggest that P-glycoprotein expression in temporal lobe may be associated with seizure recurrence after surgery for pharmacoresistant TLE.
authors.affiliation: Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. patrickkwan@cuhk.edu.hk <patrickkwan@cuhk.edu.hk>
authors.forename: Patrick
authors.initials: P
authors.lastname: Kwan
authors.forename: Hiu Ming
authors.initials: HM
authors.lastname: Li
authors.forename: Eman
authors.initials: E
authors.lastname: Al-Jufairi
authors.forename: Rawia
authors.initials: R
authors.lastname: Abdulla
authors.forename: Michael
authors.initials: M
authors.lastname: Gonzales
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Kaye
authors.forename: Cassandra
authors.initials: C
authors.lastname: Szoeke
authors.forename: Ho Keung
authors.initials: HK
authors.lastname: Ng
authors.forename: Ka Sing
authors.initials: KS
authors.lastname: Wong
authors.forename: Terence J
authors.initials: TJ
authors.lastname: O'Brien
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000378:metabolism*; D000328:Adult; D038481:Anterior Temporal Lobectomy / Q000379:methods; D042783:Endothelial Cells / Q000378:metabolism / Q000473:pathology; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005786:Gene Expression Regulation / Q000502:physiology*; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D013702:Temporal Lobe / Q000378:metabolism* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1