Epilepsy surgery is increasingly available as a successful treatment option in patients with drug‐resistant focal epilepsies when associated with distinct brain lesions. Therefore, reliable neuropathological work‐up of epilepsy‐associated brain lesions represents an important diagnostic tool in clinical epileptology, and the international classification of epilepsies recognizes a large spectrum of neuropathologic substrates as potential predictors of each patient's disease progression and treatment response. However, histopathologic standards are not yet available for all possible epileptogenic lesions, nor are they fully accepted or disseminated amongst the diagnostic pathology community. In addition, the microscopic diagnosis of epilepsy associated surgical specimens remains challenging due to the broad spectrum of disease variants. The Commissions on Diagnostic Methods (Task Force of Neuropathology) and on European Affairs of the International League against Epilepsy (ILAE‐CEA) launched its first neuropathology teaching course aimed at colleagues engaged in the diagnostic evaluation of patients with drug‐resistant focal epilepsy. The considerable interest in this first INES summer school in Erlangen, Germany was confirmed by its registration of 37 colleagues from 25 nations (Figure 1A). Most participants had a medical training record in pathology or neuropathology, although others had a primary background in neurology, neurosurgery, neuroradiology, neuropsychology or neuroscience. This multi‐disciplinary approach fostered fruitful discussions during the week and was considered most helpful in appreciating both the value and limitations of histopathologic diagnosis in epilepsy surgery.
Figure legend for A.
INES group from bottom row left to right: Jinmei Lie, Chengdu, China; Se Hoon Kim, Seoul, South Korea; Eva Lobner, Kopenhagen, Denmark; Francesco Deleo, Milano, Italy; Beatrice Paradiso, Ferrara, Italy; Laura Zaldumbe, Santander, Spain; Raffaele Nunziata, Milano, Italy; Laura Flores‐Sarnat, Calgary, Canada; Juana Villeda Hernandez, Mexico City, Mexico; 2nd row left to right: Vega Karlowee; Semarang, Indonesia; Sandra Orozco Suarez; Mexico City, Mexico; Ludmilla Shishkina, Moscow, Russia; Facundo Las Heras, Santiago, Chile; Ovidiu Tica, Oradea, Rumania; Harvey Sarnat (tutor), Calgary, Canada; Hajime Miyata (tutor), Akita, Japan; 3rd row left to right: Sophie Hamelin, Grenoble, France; Monica Mezmezian, Buenos Aires, Argentina; Lily Pal, Lucknow, India; 4th row left to right: Savo Raicevic, Belgrade, Serbia; Anne Sieben, Gent, Belgium; Elane Magno, Sao Paulo, Brazil; Theo Kraus, Munich, Germany; Roberto Spreafico (lecturer), Milano, Italy; Karl Rössler (lecturer), Erlangen, Germany; Francine Oliveira, Porto Alegre, Brazil; Ingmar Blumcke (course director and tutor), Erlangen, Germany; 5th row left to right: Gianluca Marucci, Bologna, Italy; Tuomas Rauramaa, Kuopio, Finland; Clinton Paul Turner, Auckland, New Zealand; Paul Gallagher, Glasgow, Scotland; Maria Thom (tutor), London, UK; Ricardo Taipa, Porto, Portugal; last row on top from left to right: Muchou Joe Ma, Orlando, USA; Eleonora Aronica (tutor), Amsterdam, The Netherlands; Alexey Kislyakov, Moscow, Russia; Roland Coras (course director), Erlangen, Germany; Harald Stefanits; Vienna, Austria; Marc Polivka, Paris, France; Antonia Jakovcevic, Zagreb, Kroatia; Jan Bauer (lecturer), Vienna, Austria; Andrew Gifford, Randwick, Australia; Albert Becker (tutor), Bonn, Germany; Fabio Rogerio, Campinas, Brazil.
Figure legend for B: IBRO scholarships received (from left to right) Antonia Jakovcevic (Zagreb, Kroatia), Savo Raicevic (Belgrade, Serbia), Ricardo Taipa (Porto, Portugal), Fabio Rogerio (Campinas, Brazil) and Ovidiu Tica (Oradea, Romania).
Figure legend for C: Tutors, lecturers and ISN scholars from left to right: Hajime Miyata (tutor from Akita, Japan); Ingmar Blumcke (course director and tutor from Erlangen, Germany), Fernando Cendes (lecturer from Campinas, Brazil), Lei Liu, Bejing, China; Facundo Las Heras, Santiago, Chile; Roberto Spreafico (Lecturer from Milano, Italy); Vega Karlowee, Semarang, Indonesia; Monica Mezmezian, Buenos Aires, Argentina; Francine Oliviera, Porto Alegre, Brazil.
The group was trained during 5 days by six distinguished tutors (Dr. Eleonora Aronica, Amsterdam, Dr. Albert Becker, Bonn, Dr. Ingmar Blumcke, Erlangen, Dr. Hajime Miyata, Akita, Dr. Harvey Sarnat, Calgary, and Dr. Maria Thom, London). Each tutor provided face‐to‐face interactions with his/her small group of 6–7 students, helping them to microscopically review and discuss a series of 112 glass slides obtained from 31 surgical specimens selected to cover the large spectrum of epilepsy related brain lesions and their variants, i.e. the new ILAE classification of hippocampal sclerosis (1st day), epileptic encephalitis and vascular disorders (2nd day), long‐term epilepsy associated brain tumors (3rd day) and the ILAE classification of focal cortical dysplasia (FCD) as well as other malformations of cortical development (4th and 5th day). This valuable teaching set of glass slides was prepared by the course organizers in Erlangen to offer each student free access to microscopic review and to familiarize themselves with helpful and recommended special stains, including a large panel of immunohistochemical markers. This was further supplemented by a course booklet summarizing case presentations, protocols for neuropathological work‐up, and review articles covering all major epileptogenic brain lesions. We also invited distinguished speakers experienced in the field of clinical epileptology (Dr. Eugen Trinka, Salzburg, Dr. Christian Bien, Bielefeld, Dr. Karl Rössler, Erlangen, Dr. Hans Holthausen, Vogtareuth, Dr. Fernando Cendes, Campinas), who always started the day's teaching program with a topic‐related plenary lecture introducing the principles of adult or childhood epileptology, modern imaging techniques or neurosurgical procedures.
Besides these practical teaching sessions, the interdisciplinary discussions and training environment in the microscope lecture room offered an encouraging spirit to foster clinical and scientific interest in the field of surgical neuropathology. The students’ evaluations achieved exceptional ratings, reinforcing the structure of this course with enough room and space for personal mentoring, as well as group discussions during case presentations and plenary lectures. Not to be forgotten, our social events were highly anticipated and regarded as helpful for building professional networks.
Scholarships were made available from the International Society of Neuropathology (ISN, Figure 1C) and International Brain Research Organization (IBRO, Figure 1B), which also allowed participants from low‐ and middle‐income countries to attend this course.
CEA‐ILEA support is also available for next year's 2nd INES in Erlangen. The dates will be August 30th–September 3rd, 2014 and please visit the course website at www.epilepsie‐register.de.
Both faculty and participants were confident that this course was extremely helpful in training for this rapidly emerging discipline with its new diagnostic classification schemes and many still ill‐defined disease categories, covering a huge spectrum of brain malformations, inflammatory diseases, degeneration, and tumors.
We look forward to meeting you next year in Erlangen!
Yours truthfully
Ingmar Blumcke
on behalf of INES faculty and participants 2013
Disclosure
None of the authors have any conflicts to declare. INES 2013 was financially supported by ILAE‐CEA (Commission on European Affairs of the Intl League against Epilepsy), IBRO (Intl Brain Research Organization), ISN (Intl. Society of Neuropathology) and Roche Diagnostics Deutschland GmbH (Mannheim, Germany).