Hippocampal pathology and pathophysiology in temporal lobe epilepsy. 1996

R S Sloviter
Neurology Research Center, Helen Hayes Hospital, West Haverstraw, NY 10993, USA.

Hippocampal sclerosis involves the selective loss of some hippocampal cell populations, in a process that may disturb the excitatory/inhibitory balance of the remaining cells and produce the epileptic focus. Endfolium sclerosis is the minimal common pathological change found in epileptic patients with hippocampal damage. This subtle lesion is characterized by extensive dentate hilar cell loss without a similarly severe loss of dentate granule cells or hippocampal pyramidal neurons. We attempted to reproduce endfolium sclerosis experimentally by producing dentate granule cell seizure discharges with focal electrical stimulation in anesthetized rats, thus avoiding generalized seizure activity and motor convulsions. With this model, dentate hilar neurons and CA3 pyramidal cells were selectively and irreversibly injured, replicating the pattern of human endfolium sclerosis, with hilar cell damage and survival of dentate granule cell layer GABA-containing basket cells. This results in permanent granule cell disinhibition and hyperexcitability. Excitatory deafferentation of GABAergic basket cells was probably secondary to the loss of hilar mossy cells that normally excite the GABA neurons, rendering these neurons dormant. I propose that endfolium sclerosis in humans represents a selective loss of intrinsically vulnerable dentate hilar cells that normally govern dentate granule cell excitability and that this process leads to epileptiform discharges.

UI MeSH Term Description Entries
D004833 Epilepsy, Temporal Lobe A localization-related (focal) form of epilepsy characterized by recurrent seizures that arise from foci within the TEMPORAL LOBE, most commonly from its mesial aspect. A wide variety of psychic phenomena may be associated, including illusions, hallucinations, dyscognitive states, and affective experiences. The majority of complex partial seizures (see EPILEPSY, COMPLEX PARTIAL) originate from the temporal lobes. Temporal lobe seizures may be classified by etiology as cryptogenic, familial, or symptomatic. (From Adams et al., Principles of Neurology, 6th ed, p321). Epilepsy, Benign Psychomotor, Childhood,Benign Psychomotor Epilepsy, Childhood,Childhood Benign Psychomotor Epilepsy,Epilepsy, Lateral Temporal,Epilepsy, Uncinate,Epilepsies, Lateral Temporal,Epilepsies, Temporal Lobe,Epilepsies, Uncinate,Lateral Temporal Epilepsies,Lateral Temporal Epilepsy,Temporal Lobe Epilepsies,Temporal Lobe Epilepsy,Uncinate Epilepsies,Uncinate Epilepsy
D006624 Hippocampus A curved elevation of GRAY MATTER extending the entire length of the floor of the TEMPORAL HORN of the LATERAL VENTRICLE (see also TEMPORAL LOBE). The hippocampus proper, subiculum, and DENTATE GYRUS constitute the hippocampal formation. Sometimes authors include the ENTORHINAL CORTEX in the hippocampal formation. Ammon Horn,Cornu Ammonis,Hippocampal Formation,Subiculum,Ammon's Horn,Hippocampus Proper,Ammons Horn,Formation, Hippocampal,Formations, Hippocampal,Hippocampal Formations,Hippocampus Propers,Horn, Ammon,Horn, Ammon's,Proper, Hippocampus,Propers, Hippocampus,Subiculums
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012598 Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Scleroses
D016923 Cell Death The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. Death, Cell
D017966 Pyramidal Cells Projection neurons in the CEREBRAL CORTEX and the HIPPOCAMPUS. Pyramidal cells have a pyramid-shaped soma with the apex and an apical dendrite pointed toward the pial surface and other dendrites and an axon emerging from the base. The axons may have local collaterals but also project outside their cortical region. Pyramidal Neurons,Cell, Pyramidal,Cells, Pyramidal,Neuron, Pyramidal,Neurons, Pyramidal,Pyramidal Cell,Pyramidal Neuron
D018079 Receptors, GABA Cell-surface proteins that bind GAMMA-AMINOBUTYRIC ACID with high affinity and trigger changes that influence the behavior of cells. GABA-A receptors control chloride channels formed by the receptor complex itself. They are blocked by bicuculline and usually have modulatory sites sensitive to benzodiazepines and barbiturates. GABA-B receptors act through G-proteins on several effector systems, are insensitive to bicuculline, and have a high affinity for L-baclofen. GABA Receptors,Receptors, gamma-Aminobutyric Acid,gamma-Aminobutyric Acid Receptors,GABA Receptor,gamma-Aminobutyric Acid Receptor,Receptor, GABA,Receptor, gamma-Aminobutyric Acid,Receptors, gamma Aminobutyric Acid,gamma Aminobutyric Acid Receptor,gamma Aminobutyric Acid Receptors
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