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Developmental Neurobiology, Neuroanatomy, and Neuropathology of Epilepsy 

Developmental Neurobiology, Neuroanatomy, and Neuropathology of Epilepsy
Developmental Neurobiology, Neuroanatomy, and Neuropathology of Epilepsy

Ingmar Blümcke

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date: 05 July 2022

A broad spectrum of brain lesions associates with drug-resistant, chronic seizures, and can be increasingly recognized using high-resolution imaging techniques. Epilepsy surgery has become a successful treatment option in many of these patients. Based on our neuropathologic review of 4512 surgical epilepsy brain tissue samples collected at the European Epilepsy Brain Bank, hippocampal sclerosis, glio-neuronal tumors and malformations of cortical development (Focal Cortical Dysplasias, FCD) are most prevalent. These lesions may directly establish abnormal neuronal networks thereby provoking seizures. On the other hand, early seizure onset may compromise developmental programming and maturation of adjacent brain structures, which can also result in highly epileptogenic lesion patterns. However, international classification systems and grading scales for any distinct lesion pattern need to be established. They will be mandatory to advance the diagnostic work-up, allow comparison between treatment strategies as well as addressing underlying etiologies. In this respect, the International League against Epilepsy has published a first consensus classification for FCD, which will be discussed here. A similar approach may help to negotiate common grading scales for hippocampal sclerosis. Addressing more precisely defined clinico-pathological entities will also help to clarify pathomechanisms and, thereby, develop novel pharmacological targets. Indeed, recent evidence supports the notion that developmentally compromised signalling pathways are involved in many lesions’ etiology. Translating neurodevelopmental knowledge into clinical perspectives has been, therefore, very much promoted in last years and this chapter will also review neurobiological concepts of brain development to better understand the diverse morphological spectrum of epilepsy-associated brain lesions.

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