Table 1.
Characteristics of Patients Selected for the Study
| Patient and classification | Sex | Age (years) | Time since first unprovoked seizure (years) | Antiepileptic drugs at surgery | MRI findings | Pathology |
|---|---|---|---|---|---|---|
|
Non-MTLE 1 |
F | 18 | 3 | Valproate, lamotrigine | Open lip schizencephaly, R hemisphere | Marked gliosis in cortex and white matter |
| 2 | F | 28 | 21 | Lamotrigine, zonisamide, phenytoin | Nonspecific, focal T2 signal hyperintensities in subcortical white matter, R frontal lobe | Mild to moderate neuronal loss with severe reactive gliosis. Abnormal lamination and clustering of neurons. |
| 3 | M | 4 | 2 | Oxcarbazepine | Abnormal signal of R amygdala, hippocampal head and parahippocampal gyrus with cyst near R hippocampal head | Oligodendroglioma |
| 4 | F | 49 | 13 | Carbamazepine XR, phenytoin, lamotrigine | Large mass in R frontal and R temporal lobes | Oligodendroglioma and ganglioneurocytoma |
| 5 | F | 38 | <1 | Levetiracetam | Nonenhancing R hippocampal lesion | Glioma |
| 6 | M | 13 | 9 | Phenytoin, levetiracetam, carbamazepine | Large porencephalic cavity in the R MCA distribution with surrounding gliosis. Compatible with remote R MCA infarct. | Frequent heterotopic neurons in molecular layer of cerebral cortex |
| 7 | M | 6 | Levetiracetam, lamotrigine | Abnormal gray matter with local mass-effect involving L frontal cortex. Possible localized hemimegalencephaly and cortical dysplasia. | Cortical dysplasia | |
| 8 | M | 69 | 7 | Phenytoin | Neoplastic lesion, R temporal lobe | Oligodendroglioma |
| 9 | F | 10 | 5 | Lamotrigine | R temporal tumor | Low-grade astrocytoma |
| 10 | M | 28 | 26 | Carbamazepine, acetazolamide | Ectopic gray matter adjacent to L anterior horn. High-signal by FLAIR in R posterior temporal lobe with corresponding low T1 signal. Possible bilateral hippocampal atrophy. | Heterotopic neurons in the molecular layer of the dentate gyrus. Subpial glial cell proliferation. |
| 11 | M | 40 | 35 | Valproate, levetiracetam | Normal | Hippocampus w/no significant neuronal loss. White matter shows increased number of glial cells. |
| 12 | F | 8 | 4 | Carbamazepine | L temporal tumor | Oligodendroglioma |
| 13 | M | 44 | 26 | Carbamazepine, clonazepam | Possible R mesial temporal sclerosis | Hippocampus w/mild, diffuse neuronal loss and mild to moderate increase in number of white matter glial cells. |
|
MTLE 14 |
F | 17 | 5 | Oxcarbazepine, lamotrigine, carbamazepine | Heterotopic gray matter in posterior R temporal lobe white matter with extension to the atrium and body of the right lateral ventricle. | Hippocampal sclerosis |
| 15 | M | 57 | 39 | Phenytoin, carbamazepine, topiramate, levetiracetam | Mesial temporal sclerosis | Hippocampal sclerosis |
| 16 | F | 51 | 48 | Levetiracetam, pregabalin | R mesial temporal sclerosis | Hippocampal sclerosis |
| 17 | F | 40 | 28 | Felbamate, topiramate, gabapentin, carbamazepine | L hippocampal sclerosis | Hippocampal sclerosis |
| 18 | M | 63 | 45 | Gabapentin, lamotrigine, levetiracetam | R hippocampal sclerosis | Hippocampal sclerosis |
| 19 | M | 28 | 6 | Valproate, phenytoin | Encephalomalacia, R anteromedial frontal lobe. Hemosiderin, R and L frontal and temporal lobes and L parietal lobe. Possible gliosis/scarring in white matter of R frontal lobe, L superior frontal gyrus and L parietal lobe. | Hippocampal sclerosis |
| 20 | F | 42 | 7 | Levetiracetam, oxcarbazepine | R hippocampal sclerosis | Hippocampal sclerosis |
| 21 | F | 40 | 37 | Carbamazepine, levetiracetam, zonisamide | L hippocampal sclerosis | Hippocampal sclerosis |
| 22 | M | 62 | 56 | Valproate, levetiracetam, phenytoin | L mesial temporal sclerosis | Hippocampal sclerosis |
| 23 | F | 40 | 27 | Carbamazepine, levetiracetam | Increased T2 signal, L hippocampus | Hippocampal sclerosis |
| 24 | F | 46 | 41 | Carbamazepine, primidone | L mesial temporal sclerosis | Hippocampal sclerosis |
| 25 | F | 30 | 22 | Zonisamide, carbamazepine XR | R mesial temporal sclerosis | Hippocampal sclerosis |
| 26 | F | 51 | 11 | Carbamazepine | L mesial temporal sclerosis | Hippocampal sclerosis |
| 27 | F | 37 | 11 | Primidone, Lamotrigine | R mesial temporal sclerosis | Hippocampal sclerosis |
| 28 | F | 15 | 5 | Carbamazepine XR, lamotrigine | L mesial temporal sclerosis | Hippocampal sclerosis |
| Patient and classification | Sex | Age (years) | Cause of death |
|---|---|---|---|
|
Autopsy 1 |
M | 33 | Adenocarcinoma of lung with widespread metastases |
| 2 | M | 52 | Myocardial infarct, coronary atherosclerosis |
| 3 | F | 49 | Ruptured berry aneurysm, R posterior inferior cerebellar artery |
| 4 | F | 76 | Peritonitis |
| 5 | M | 61 | Myocardial infarct, cardiovascular atherosclerosis |
| 6 | F | 62 | Dementia, Alzheimer’s disease, Parkinson’s disease |
| 7 | M | 87 | Aspiration pneumonia, severe atherosclerotic vascular disease |
| 8 | F | 47 | Asthma, morbid obesity |
Abbreviations: L, left; MCA, middle cerebral artery; R, right; XR, extended release