Hippocampal sclerosis in epilepsy: a neuropathology review

M Thom - Neuropathology and applied neurobiology, 2014 - Wiley Online Library
M Thom
Neuropathology and applied neurobiology, 2014Wiley Online Library
Hippocampal sclerosis (HS) is a common pathology encountered in mesial temporal lobe
epilepsy (MTLE) as well as other epilepsy syndromes and in both surgical and post‐mortem
practice. The 2013 I nternational L eague A gainst E pilepsy (ILAE) classification segregates
HS into typical (type 1) and atypical (type 2 and 3) groups, based on the histological patterns
of subfield neuronal loss and gliosis. In addition, granule cell reorganization and alterations
of interneuronal populations, neuropeptide fibre networks and mossy fibre sprouting are …
Hippocampal sclerosis (HS) is a common pathology encountered in mesial temporal lobe epilepsy (MTLE) as well as other epilepsy syndromes and in both surgical and post‐mortem practice. The 2013 International League Against Epilepsy (ILAE) classification segregates HS into typical (type 1) and atypical (type 2 and 3) groups, based on the histological patterns of subfield neuronal loss and gliosis. In addition, granule cell reorganization and alterations of interneuronal populations, neuropeptide fibre networks and mossy fibre sprouting are distinctive features of HS associated with epilepsies; they can be useful diagnostic aids to discriminate from other causes of HS, as well as highlighting potential mechanisms of hippocampal epileptogenesis. The cause of HS remains elusive and may be multifactorial; the contribution of febrile seizures, genetic susceptibility, inflammatory and neurodevelopmental factors are discussed. Post‐mortem based research in HS, as an addition to studies on surgical samples, has the added advantage of enabling the study of the wider network changes associated with HS, the long‐term effects of epilepsy on the pathology and associated comorbidities. It is likely that HS is heterogeneous in aspects of its cause, epileptogenetic mechanisms, network alterations and response to medical and surgical treatments. Future neuropathological studies will contribute to better recognition and understanding of these clinical and patho‐aetiological subtypes of HS.
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