title: Hippocampal atrophy on MRI is predictive of histopathological patterns and surgical prognosis in mesial temporal lobe epilepsy with hippocampal sclerosis.
abstract: To correlate hippocampal volumes obtained from brain structural imaging with histopathological patterns of hippocampal sclerosis (HS), in order to predict surgical outcome.
  
  
  
  Patients with mesial temporal lobe epilepsy (MTLE) with HS were selected. Clinical data were assessed pre-operatively and surgical outcome in the first year post surgery. One block of mid hippocampal body was selected for HS classification according to ILAE criteria. NeuN-immunoreactive cell bodies were counted within hippocampal subfields, in four randomly visual fields, and cell densities were transformed into z-score values. FreeSurfer processing of 1.5T brain structural images was used for subcortical and cortical volumetric estimation of the ipsilateral hippocampus. Univariate analysis of variance and Pearson's correlation test were applied for statistical analyses.
  
  
  
  Sixty-two cases (31 female, 32 right HS) were included. ILAE type 1 HS was identified in 48 patients, type 2 in eight, type 3 in two, and four had no-HS. Better results regarding seizure control, i.e. ILAE 1, were achieved by patients with type 1 HS (58.3%). Patients with types 1 and 2 had smaller hippocampal volumes compared to those with no-HS (p<0.001 and p=0.004, respectively). Positive correlation was encountered between hippocampal volumes and CA1, CA3, CA4, and total estimated neuronal densities. CA2 was the only sector which did not correlate its neuronal density with hippocampal volume (p=0.390).
  
  
  
  This is the first study correlating hippocampal volume on MRI submitted to FreeSurfer processing with ILAE patterns of HS and neuronal loss within each hippocampal subfield, a fundamental finding to anticipate surgical prognosis for patients with drug-resistant MTLE and HS.
authors.affiliation: Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650 - Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil. Electronic address: anaclarapjardim@gmail.com.
authors.forename: Anaclara Prada
authors.initials: AP
authors.lastname: Jardim
authors.affiliation: Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650 - Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
authors.forename: Jeana Torres
authors.initials: JT
authors.lastname: Corso
authors.affiliation: Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650 - Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
authors.forename: Maria Teresa Fernandes Castilho
authors.initials: MT
authors.lastname: Garcia
authors.affiliation: Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650 - Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
authors.forename: Larissa Botelho
authors.initials: LB
authors.lastname: Gaça
authors.affiliation: Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650 - Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
authors.forename: Sandra Mara
authors.initials: SM
authors.lastname: Comper
authors.affiliation: Department of Pathological Sciences, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesáreo Motta Jr., 61 - Vila Buarque, CEP 01221-020, São Paulo, SP, Brazil.
authors.forename: Carmen Lúcia Penteado
authors.initials: CL
authors.lastname: Lancellotti
authors.affiliation: Neurosurgery Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 715, 6° andar - Vila Clementino, CEP 04024-002, São Paulo, SP, Brazil.
authors.forename: Ricardo Silva
authors.initials: RS
authors.lastname: Centeno
authors.affiliation: Diagnostic Imaging Sector, Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, CEP 04024-002, São Paulo, SP, Brazil.
authors.forename: Henrique
authors.initials: H
authors.lastname: Carrete
authors.affiliation: Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 2° andar - Vila Clementino, CEP 04039-032, São Paulo, SP, Brazil.
authors.forename: Esper Abrão
authors.initials: EA
authors.lastname: Cavalheiro
authors.affiliation: Neuroscience Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 669, 2° andar - Vila Clementino, CEP 04039-032, São Paulo, SP, Brazil.
authors.forename: Carla Alessandra
authors.initials: CA
authors.lastname: Scorza
authors.affiliation: Clinical Neurology Sector, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), Rua Pedro de Toledo, 650 - Vila Clementino, CEP 04039-002, São Paulo, SP, Brazil.
authors.forename: Elza Márcia Targas
authors.initials: EM
authors.lastname: Yacubian
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D034961:Antigens, Nuclear / Q000378:metabolism; D001284:Atrophy; D002452:Cell Count; D000069279:Drug Resistant Epilepsy / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000378:metabolism; D009929:Organ Size; D011379:Prognosis; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D034961:Antigens, Nuclear; D009419:Nerve Tissue Proteins; C506808:neuronal nuclear antigen NeuN, human
keywords: FreeSurfer analysis; Hippocampal atrophy; Hippocampal sclerosis; Mesial temporal lobe epilepsy; Surgical outcome