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Neurology India, Vol. 54, No. 2, April-June, 2006, pp. 150-151 Invited Comments Invited Comments Schaller Carlo Leitender Oberarzt, Neurochirurgische Universitätsklinik, Sigmund-Freud-Str. 25, 53127 Bonn Code Number: ni06042 Related articles: ni06041, ni06043 This retrospective study analyzes the results of neuropathological examinations in a total of 153 specimens, which were obtained at surgery for chronic epilepsy in an Indian neurosurgical center. The main site of origin of the epilepsy was the temporal lobe in app. 75% of patients with 33% of those having exhibited mesial temporal sclerosis (MTS). Other lesions found represent a mix of developmental malformations such as focal cortical dysplasia (FCD), or the far and more neoplastic end of such malformations - e.g., DNT and some rare findings such as Rasmussen´s encephalitis or parasitic cysts. This is very interesting for the reader insofar as the rate of pharmacoresistant epilepsies which are amenable for epilepsy surgery in the present series shows a similar distribution as the one in the relevant literature on that matter with app. ¾ of those patients suffering from temporal lobe epilepsy. What´s surprising, however, is the fact that only one third of the latter patients is suffering from mesial temporal lobe or Ammons Horn sclerosis, which shows a higher incidence in reports from Western epilepsy surgical centers. This may be due to the fact that almost 60% of the included patients belong to the pediatric age group, which is known to have a higher propensity for developmental lesions causing their epilepsy. None of the results comes as a surprise for those working in large epilepsy surgical centers and similar series with similar results were already reported.[3],[4] Nowadays, molecular neuropathologists and neurophysiologists focus more on the genetic background and on the development of epileptogenic lesions, many of which seem to represent only one stage of a mere continuum or a single class of entities and on the underlying structural abnormalities and signal transduction.[1],[2] The authors are to be congratulated, however, for giving a comprehensive overview of these yet interesting findings and thereby possibly raising the interest of the clinical neuroscientists community of the Indian subcontinent for the fascinating field of epilepsy surgery. In the future it would be interesting to read more from this group with particular focus on the mode of their preoperative evaluation and on seizure outcome - for comparison with other clinical series. References
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