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Objective: Biologic substrates behind the close association between mesial temporal lobe epilepsy (MTLE) and psychiatric comorbidities are largely unknown. Heat shock protein 70 (HSP70) and HSP90 are ubiquitous molecular chaperones that play important roles in functions from cellular stress response to receptor trafficking control. There are controversial findings regarding HSP expression in epilepsy. Our goal was to examine HSP70 and HSP90 expression within the human hippocampal formation of MTLE patients with and without comorbid major depression and psychosis. In addition, we investigated the possible correlation between HSP expression and seizure outcome., Methods: MTLE hippocampi of subjects without psychiatric history, MTLE and major depression, and MTLE and interictal psychosis derived from epilepsy surgery and control necropsies were investigated for neuronal densities, HSP70 and HSP90 immunoreactive area., Results: Increased HSP expression in MTLE and decreased HSP expression in MTLE with psychosis cases were detailed. Patients taking fluoxetine showed increased HSP90 expression in CA1, and those taking haloperidol decreased HSP90 in the granular layer and subiculum. MTLE patients with complete seizure remission presented with decreased HSP70 expression in CA4 and subiculum and decreased HSP90 expression in the granular layer., Significance: The present results provide the first demonstration of HSP expression in human MTLE hippocampal formation with and without psychiatric comorbidities. Distinct HSP70 and HSP90 expression might explain some of the structural and synaptic alterations differentially regulated in MTLE with and without psychiatric comorbidities. Increased HSPs expression in key hippocampal subfields would reflect increased epileptogenicity and poorer outcome of epilepsy surgery., (Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.)

Purpose: We sought to analyze the contralateral volumes of the temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus in patients with temporal lobe epilepsy (TLE) due to histologically proven mesial temporal lobe sclerosis (MTLS), seizure free for >or=4 years of postsurgical follow-up., Methods: Forty-six (23 male) TLE patients, operated on between 1996 and 2001, with histopathologic diagnosis of MTLS, and a postsurgical follow-up of >or=4 years, had their temporal lobe structures manually segmented, measured, and compared with those of 23 normal volunteers, paired as groups for sex, age, and handedness., Results: The mean volumes of the contralateral temporal pole, hippocampus, and parahippocampal gyrus in TLE patients were significantly lower than those in controls., Conclusions: MRI volumetric data show that the damage in TLE due to MTS may be more widespread and bilateral, even in patients with unilateral TLE by clinical and neurophysiological criteria. Our results are relevant to the discussion of epileptogenic mechanisms in TLE.

Purpose: Posterior cortex epilepsies (PCEs) encompass a group of epilepsies originating from the occipital, parietal, or occipital border of the temporal lobe, or from any combination of these regions. When their seizures are refractory to pharmacologic treatment, these patients are usually referred for surgery. The aim of our study was to analyze clinical characteristics of all PCE patients referred for surgery from 1994 to 2003, and to search for predictors of surgical outcome., Methods: We performed a retrospective analysis of clinical and laboratory data from 81 consecutive refractory PCE patients referred for surgery. Surgical and nonsurgical groups of patients were compared, and detailed analyses of all variables of the surgical cases were performed in the search for predictors of seizure outcome., Results: Risk factors for PCEs included gliosis (34.56%), malformations of cortical development (33.33%), tumors (8.64%), brain trauma (3.70%), Sturge-Weber disease (4.93%), vascular malformations (3.70%), family history of epilepsy (3.70%), history of CNS infections (2.46%), and low IQ (2.46%). Of the 81 patients, 44 were submitted to surgery at the time of the completion of this study. Surgical treatment was highly effective in improving seizures (p<0.001) when compared with previous pharmacologic treatment alone. Twenty-eight (65.11%) patients became seizure free after surgery versus none in the nonsurgical group. Regarding outcome predictors, patients with shorter duration of epilepsy and those without neurologic abnormalities on clinical examination had higher chances of favorable evolution., Conclusions: Surgical treatment is effective for the treatment of PCEs and superior to pharmacologic therapy alone. In our series, shorter duration of epilepsy and normal neurologic examination were the only independent variables that predicted better surgical outcome.