{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:56:11Z","timestamp":1791280571587,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Temporal lobe encephaloceles (ENCs) are underdiagnosed causes of drug\u2010resistant temporal lobe epilepsy (TLE), frequently associated with idiopathic intracranial hypertension (IIH). Emerging evidence suggests glymphatic system dysfunction in both IIH and TLE. We investigated glymphatic markers in TLE associated with ENC compared with seizure\u2010free postoperative TLE controls of different etiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      <jats:bold>S<\/jats:bold>\n                      urgical specimens from 13 patients with TLE\u2010ENC and 12 TLE\u2010control patients were analyzed. Histological glymphatic markers included aquaporin\u20104 (AQP4), glial fibrillary acidic protein (GFAP), podoplanin, perivascular space (PVS) enlargement, and vessel density. High\u2010resolution magnetic resonance imaging (MRI) was used to assess a global PVS score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with specimens TLE controls, TLE\u2010ENC specimens showed increased white matter AQP4 expression and AQP4\/GFAP ratio, whereas the AQP4\/GFAP ratio was reduced in gray matter. Podoplanin expression was significantly elevated in both gray and white matter in TLE\u2010ENC cases. MRI demonstrated greater supratentorial PVS enlargement in ENC patients. Radiological features suggestive of IIH were identified in 46.1% of TLE\u2010ENC patients. Compared with controls, TLE\u2010ENC patients had shorter disease duration and lacked association with previous febrile seizures. Surgical treatment achieved seizure freedom in 70% of ENC patients at a median follow\u2010up of 32\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This study provides the first characterization of glymphatic\u2010associated pathways in TLE\u2010ENC\u2013related epilepsy. Dysregulation of AQP4 and podoplanin, together with increased PVS burden, suggests a distinct alteration of perivascular and astroglial homeostasis in TLE\u2010ENC, supporting a potential pathophysiological link among ENC formation, IIH, and epileptogenesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70522","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:36:32Z","timestamp":1791279392000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glymphatic system in temporal lobe epilepsy associated with encephalocele"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4202-955X","authenticated-orcid":false,"given":"Roberta","family":"Di Giacomo","sequence":"first","affiliation":[{"name":"Epilepsy Unit Fondazione IRCCS Istituto Neurologico Carlo Besta  Milan 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Istituto Neurologico Carlo Besta  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Parente","sequence":"additional","affiliation":[{"name":"Epilepsy Unit Fondazione IRCCS Istituto Neurologico Carlo Besta  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4812-6310","authenticated-orcid":false,"given":"Giuseppe","family":"Didato","sequence":"additional","affiliation":[{"name":"Epilepsy Unit Fondazione IRCCS Istituto Neurologico Carlo Besta  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0808-3042","authenticated-orcid":false,"given":"Francesco","family":"Deleo","sequence":"additional","affiliation":[{"name":"Epilepsy Unit Fondazione IRCCS Istituto Neurologico Carlo Besta  Milan 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