The European Epilepsy Brain Bank Consortium: 25 years of experience with neuropathology and epilepsy surgery in 9523 children and adults

A recent article published in the New England Journal of Medicine described histopathological findings in brain tissue obtained during epilepsy surgery in 2,623 children and 6,900 adults. The European Epilepsy Brain Bank was established at the University Hospital in Erlangen, Germany in 2006 with support of the 6th and 7th Health Framework Program of the European Union (DESIRE grant agreement # 602531). 36 centers in 12 European countries participated in the study, contributing with a minimal data set of de-identified clinico-pathological data. Overall, 36 histopathological diagnosis were obtained, that could be classified into 7 major disease categories.

The 10 most common histopathological diagnoses explained 86.6 % of the entire series. 75.9% of patients had seizure onset in childhood, whereas 72.5% were operated as adults. Among the 7,168 patients for whom reporting of postsurgical outcome was available, post hoc analysis indicated that 60.7% (66.4% of children and 58.6% of adults) were seizure-free 1 year after surgery (ILAE 1, Engel class IA). Hippocampal sclerosis was the most common histopathological diagnosis among adults, and focal cortical dysplasia was the most common diagnosis among children. Tumors were the second most common lesion in both groups. Overall, 7.7% of patients had microscopically no identifiable lesion. This group of patients deserves further attention as it may include novel disease entities or molecular signatures directly implicated in the genesis of the seizure. The EEBB database will help to further establish epilepsy surgery as a successful therapeutic pathway in patients with difficult-to-treat focal epilepsies, particularly in children.

Histopathological Findings in Brain Tissue Obtained during Epilepsy Surgery
Ingmar Blümcke et al. N Engl J Med 2017; 377:1648-1656. October 26, 2017. DOI: 10.1056/NEJMoa1703784

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