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Epilepsia. 2016 Mar;57(3):348-58. doi: 10.1111/epi.13319. Epub 2016 Feb 3.

International recommendation for a comprehensive neuropathologic workup of epilepsy surgery brain tissue: A consensus Task Force report from the ILAE Commission on Diagnostic Methods.

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Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany.
Epilepsy Center, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
Department of (Neuro)Pathology, Academic Medisch Centrum (AMC), Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
SEIN Epilepsy Institute in the Netherlands, Heemstede, The Netherlands.
Department of Neuropathology, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
Departments of Paediatrics, Pathology (Neuropathology), and Clinical Neurosciences, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Department of Neuropathology, Institute of Neurology, University College London, London, United Kingdom.
Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany.
Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Göteborg, Gothenburg, Sweden.
2nd Faculty of Medicine, Motol University Hospital, Charles University in Prague, Prague, Czech Republic.
Departments of Clinical Neurosciences, Community Health Sciences, and Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Epilepsy Clinic and Experimental Neurophysiology, IRCCS Foundation Neurological Institute "Carlo Besta", Milan, Italy.


Epilepsy surgery is an effective treatment in many patients with drug-resistant focal epilepsies. An early decision for surgical therapy is facilitated by a magnetic resonance imaging (MRI)-visible brain lesion congruent with the electrophysiologically abnormal brain region. Recent advances in the pathologic diagnosis and classification of epileptogenic brain lesions are helpful for clinical correlation, outcome stratification, and patient management. However, application of international consensus classification systems to common epileptic pathologies (e.g., focal cortical dysplasia [FCD] and hippocampal sclerosis [HS]) necessitates standardized protocols for neuropathologic workup of epilepsy surgery specimens. To this end, the Task Force of Neuropathology from the International League Against Epilepsy (ILAE) Commission on Diagnostic Methods developed a consensus standard operational procedure for tissue inspection, distribution, and processing. The aims are to provide a systematic framework for histopathologic workup, meeting minimal standards and maximizing current and future opportunities for morphofunctional correlations and molecular studies for both clinical care and research. Whenever feasible, anatomically intact surgical specimens are desirable to enable systematic analysis in selective hippocampectomies, temporal lobe resections, and lesional or nonlesional neocortical samples. Correct orientation of sample and the sample's relation to neurophysiologically aberrant sites requires good communication between pathology and neurosurgical teams. Systematic tissue sampling of 5-mm slabs along a defined anatomic axis and application of a limited immunohistochemical panel will ensure a reliable differential diagnosis of main pathologies encountered in epilepsy surgery.


Brain; Encephalitis; Epilepsy; Glia; Malformation; Neuron; Neuropathology; Seizure; Tumor

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