Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis

• Published in: Neurological sciences Vol. 40; no. 3; pp. 495 - 502
• Main Authors: Mehvari Habibabadi, Jafar, Badihian, Shervin, Tabrizi, Nasim, Manouchehri, Navid, Zare, Mohammad, Basiratnia, Reza, Barekatain, Majid, Moein, Houshang, Mehvari Habibabadi, Amirali, Moein, Payam, Gookizadeh, Peyman
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2019; Springer Nature B.V
• Subjects: Convulsions & seizures; Cortex; Drug resistance; Dysplasia; EEG; Epilepsy; Gliosis; Hippocampus; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Article; Pathology; Psychiatry; Sclerosis; Seizures; Hippocampal sclerosis; Dual pathology; Mesial temporal sclerosis; Drug-resistant epilepsy
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-018-3677-7

Purpose
Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS.
Methods
This is a cross-sectional study conducted during 2007–2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS.
Results
Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (
P
value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (
P
 > 0.05).
Conclusions
We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.