title: High-throughput, automated quantification of white matter neurons in mild malformation of cortical development in epilepsy.
abstract: BACKGROUND
  In epilepsy, the diagnosis of mild Malformation of Cortical Development type II (mMCD II) predominantly relies on the histopathological assessment of heterotopic neurons in the white matter. The exact diagnostic criteria for mMCD II are still ill-defined, mainly because findings from previous studies were contradictory due to small sample size, and the use of different stains and quantitative systems. Advance in technology leading to the development of whole slide imaging with high-throughput, automated quantitative analysis (WSA) may overcome these differences, and may provide objective, rapid, and reliable quantitation of white matter neurons in epilepsy. This study quantified the density of NeuN immunopositive neurons in the white matter of up to 142 epilepsy and control cases using WSA. Quantitative data from WSA was compared to two other systems, semi-automated quantitation, and the widely accepted method of stereology, to assess the reliability and quality of results from WSA.
  
  
  RESULTS
  All quantitative systems showed a higher density of white matter neurons in epilepsy cases compared to controls (P = 0.002). We found that, in particular, WSA with user-defined region of interest (manual) was superior in terms of larger sampled size, ease of use, time consumption, and accuracy in region selection and cell recognition compared to other methods. Using results from WSA manual, we proposed a threshold value for the classification of mMCD II, where 78% of patients now classified with mMCD II were seizure-free at the second post-operatively follow up.
  
  
  CONCLUSIONS
  This study confirms the potential role of WSA in future quantitative diagnostic histology, especially for the histopathological diagnosis of mMCD.
authors.forename: Joan Y W
authors.initials: JY
authors.lastname: Liu
authors.forename: Matthew
authors.initials: M
authors.lastname: Ellis
authors.forename: Hannah
authors.initials: H
authors.lastname: Brooke-Ball
authors.forename: Jane
authors.initials: J
authors.lastname: de Tisi
authors.forename: Sofia H
authors.initials: SH
authors.lastname: Eriksson
authors.forename: Sebastian
authors.initials: S
authors.lastname: Brandner
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Sisodiya
authors.affiliation: Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, WC1N 3BG London, UK. m.thom@ucl.ac.uk.
authors.forename: Maria
authors.initials: M
authors.lastname: Thom
mesh_terms: D000328:Adult; D002452:Cell Count; D001330:Electronic Data Processing; D004827:Epilepsy / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D054220:Malformations of Cortical Development / Q000209:etiology* / Q000473:pathology*; D009474:Neurons / Q000473:pathology*; D010751:Phosphopyruvate Hydratase / Q000378:metabolism; D015203:Reproducibility of Results; D013997:Time Factors; D066127:White Matter / Q000473:pathology*
chemical_list: D010751:Phosphopyruvate Hydratase