Pathology-Based Approach to Seizure Outcome after Surgery for Pharmacoresistant Medial Temporal Lobe Epilepsy

Matteo Martinoni, Pier Paolo Berti, Gianluca Marucci, Guido Rubboli, Lilia Volpi, Patrizia Riguzzi, Federica Marliani, Francesco Toni, Francesca Bisulli, Paolo Tinuper, Roberto Michelucci, Agostino Baruzzi, Marco Giulioni

Research output: Contribution to journalArticlepeer-review


Background Hippocampal sclerosis (HS) is the most common cause of drug-resistant medial temporal lobe epilepsy (MTLE). Structural abnormalities such as HS, granule cell pathology (GCP), and focal cortical dysplasia (FCD) have been classified histopathologically, possibly allowing a more accurate assessment of prognostic seizure and neuropsychologic outcomes. We correlated seizure outcome with comprehensive temporal lobe pathologic findings, identified according to the most recent classification systems of HS, GCP, and FCD. Methods All the 83 patients who underwent anterior temporal lobectomy (ATL) for drug-resistant MTLE and with a proven diagnosis of HS between April 2001 and May 2014 were collected. Patients were divided in 2 main groups: 1) isolated HS with/without GCP (HS +/- GCP); and 2) HS associated with FCD with/without GCP (HS+FCD +/- GCP). Patients were followed up at least 1 year, and seizure outcome was reported in accordance with Engel classification. Results Group I: HS +/- GCP: Statistical analysis confirmed a better outcome in HS + GCP patients than in HS-no GCP (P <0.05). Moreover, a better outcome for the patients affected by GCP type I was observed (P <0.05). Group II: HS+FCD +/- GCP: Patients with HS variant type I presented a better seizure outcome than the patients with HS type II (Engel class IA HS type I vs. type II: 69% vs. 40%). Conclusions A pathology-based approach to epilepsy surgery might improve the interpretation of the results, could predict which cases will enjoy a better seizure outcome, and could help to the comprehension of the causes of failures.

Original languageEnglish
Pages (from-to)448-453
Number of pages6
JournalWorld Neurosurgery
Publication statusPublished - Jun 1 2016


  • Epilepsy surgery
  • Focal cortical dysplasia
  • Granule cell pathology
  • Hippocampal sclerosis
  • Seizure outcome
  • Temporal lobe epilepsy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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