Hippocampal pathology in patients with intractable seizures and temporal lobe masses

The authors examined hippocampal tissue removed during surgical procedures in 17 patients with intractable epilepsy who were found by preoperative magnetic resonance imaging or computerized tomography to have intra-axial masses in the temporal lobe. Neuronal densities in the cornu ammonis (CA) fields of the hippocampus and in the dentate granule cell layer were measured in hematoxylin and eosin-stained sections and were found to be lower compared to a group of 18 autopsy controls. The neuronal densities in all hippocampal fields except CA2 were related to the patient's age at seizure onset. Patients with an earlier onset of seizures had lower neuronal densities. With the exception of CA4, neuronal densities were not significantly related to the duration of the seizure disorder. Cell counts in all fields except CA2 were also related to the location of the lesion in the temporal lobe. Patients with mesial temporal lesions had lower neuronal counts. These results suggest increased vulnerability of hippocampal cytoarchitecture to proximal lesions with early ictal manifestation.