Literature Monitor

The Pathological Underpinning of Drug-Resistant Epilepsy

N Engl J Med; 2017; Oct 26; Blumcke et al.


Among patients with drug resistant focal epilepsy who underwent surgery, an examination of resected brain specimens revealed hippocampal sclerosis to be the most common histopathological diagnosis in adults. The same analysis, published in the New England Journal of Medicine, found children were most likely to have focal cortical dysplasia.

  • The study included analysis of brain specimens from 9523 patients who underwent epilepsy surgery in 36 centers in 12 European countries over 25 years.
  • About 3 of 4 patients began having seizures before age 18 years.
  • 72.5% of patient had surgery as adults.
  • On average, adult patients had endured epilepsy for about 20 years before having surgery while children waited 5.3 years for surgical resection.
  • Hippocampal sclerosis was found in 36.4% of patients, including 88.7% of adults.
  • Tumors were detected in 23.6%, most of which were ganglioglioma.
  • Malformations of cortical development affected 19.8% of patients.

Blumcke I, Spreafico R, Haaker G, et al. Histopathological findings in brain tissue obtained during epilepsy surgery. N Engl J Med. 2017;377(17):1648-1656.

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