Corpora amylacea in mesial temporal lobe epilepsy: Clinico-pathological correlations

SummaryPurposeTo investigate the electro-clinical significance of premature accumulation of corpora amylacea (CoA) in the resected hippocampus of patients with medically refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS).MethodsWe compared the clinical and EEG characteristics, and post-operative seizure outcome of 373 (mean age 29.4 years, range 7–55 years) surgically treated MTLE-HS patients with (MTLE-HS-CoA+, n = 129 [34.5%]) and without (MTLE-HS-CoA−, n = 244 [65.5%]) CoA.ResultsAge at surgery was significantly higher and duration of epilepsy before surgery was significantly longer for MTLE-HS-CoA+ patients compared to MTLE-HS-CoA− patients. Although the distribution of interictal epileptiform EEG abnormalities did not differ, type 1 ictal EEG pattern was more frequent in MTLE-HS-CoA+ patients. Among the 21 patients with major interictal psychosis detected prior to epilepsy surgery, 19 (90.5%) belonged to MTLE-HS-CoA+ group. Schizophrenia-like psychosis was most prevalent. The post-operative seizure-free outcome was comparable, but significantly more MTLE-HS-CoA− patients were free of antiepileptic drugs.ConclusionsOverall, our observations support the hypothesis that the pathological process in MTLE-HS is progressive. MTLE-HS-CoA+ patients are predisposed to increased psychiatric morbidity. In vivo detection of hippocampal CoA accumulation in the future will help us to understand the neurobiological significance of this phenomenon.