{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:31:00Z","timestamp":1787243460412,"version":"build-2736575974"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:00:00Z","timestamp":1660780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Drug-resistant mesial-temporal lobe epilepsy is a devastating disease with seizure onset in the hippocampal formation. A fraction of hippocampi samples from epilepsy-surgical procedures reveals a peculiar histological pattern referred to as \u2018gliosis only\u2019 with unresolved pathogenesis and enigmatic sequelae. Here, we hypothesize that \u2018gliosis only\u2019 represents a particular syndrome defined by distinct clinical and molecular characteristics.<\/jats:p>\n                  <jats:p>We curated an in-depth multiparameter integration of systematic clinical, neuropsychological as well as neuropathological analysis from a consecutive cohort of 627 patients, who underwent hippocampectomy for drug-resistant temporal lobe epilepsy. All patients underwent either classic anterior temporal lobectomy or selective amygdalohippocampectomy. On the basis of their neuropathological exam, patients with hippocampus sclerosis and \u2018gliosis only\u2019 were characterized and compared within the whole cohort and within a subset of matched pairs. Integrated transcriptional analysis was performed to address molecular differences between both groups.<\/jats:p>\n                  <jats:p>\u2018Gliosis only\u2019 revealed demographics, clinical and neuropsychological outcome fundamentally different from hippocampus sclerosis. \u2018Gliosis only\u2019 patients had a significantly later seizure onset (16.3 versus 12.2 years, P = 0.005) and worse neuropsychological outcome after surgery compared to patients with hippocampus sclerosis. Epilepsy was less amendable by surgery in \u2018gliosis only\u2019 patients, resulting in a significantly worse rate of seizure freedom after surgery in this subgroup (43% versus 68%, P = 0.0001, odds ratio = 2.8, confidence interval 1.7\u20134.7). This finding remained significant after multivariate and matched-pairs analysis. The \u2018gliosis only\u2019 group demonstrated pronounced astrogliosis and lack of significant neuronal degeneration in contrast to characteristic segmental neuron loss and fibrillary astrogliosis in hippocampus sclerosis. RNA-sequencing of gliosis only patients deciphered a distinct transcriptional programme that resembles an innate inflammatory response of reactive astrocytes.<\/jats:p>\n                  <jats:p>Our data indicate a new temporal lobe epilepsy syndrome for which we suggest the term \u2018Innate inflammatory gliosis only\u2019. \u2018Innate inflammatory gliosis only\u2019 is characterized by a diffuse gliosis pattern lacking restricted hippocampal focality and is poorly controllable by surgery. Thus, \u2018innate inflammatory gliosis only\u2019 patients need to be clearly identified by presurgical examination paradigms of pharmacoresistant temporal lobe epilepsy patients; surgical treatment of this subgroup should be considered with great precaution. \u2018Innate inflammatory gliosis only\u2019 requires innovative pharmacotreatment strategies.<\/jats:p>","DOI":"10.1093\/brain\/awac293","type":"journal-article","created":{"date-parts":[[2022,8,18]],"date-time":"2022-08-18T00:48:30Z","timestamp":1660783710000},"page":"549-560","source":"Crossref","is-referenced-by-count":40,"title":["\u2018Hippocampal innate inflammatory gliosis only\u2019 in pharmacoresistant temporal lobe epilepsy"],"prefix":"10.1093","volume":"146","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3846-9846","authenticated-orcid":false,"given":"Alexander","family":"Grote","sequence":"first","affiliation":[{"name":"Clinic for Neurosurgery, University Hospital of Marburg , 35033 Marburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter-Henrik","family":"Heiland","sequence":"additional","affiliation":[{"name":"Clinic for Neurosurgery, University Medical Center Freiburg , 79106 Freiburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Taube","sequence":"additional","affiliation":[{"name":"Clinic for Epileptology, University Hospital of Bonn , 53127 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Helmstaedter","sequence":"additional","affiliation":[{"name":"Clinic for Epileptology, University Hospital of Bonn , 53127 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidhya M","family":"Ravi","sequence":"additional","affiliation":[{"name":"Clinic for Neurosurgery, University Medical Center Freiburg , 79106 Freiburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Will","sequence":"additional","affiliation":[{"name":"Clinic for Neurosurgery, University Medical Center Freiburg , 79106 Freiburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elke","family":"Hattingen","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Hospital of Goethe University Frankfurt , 60528 Frankfurt am Main , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-R\u00fcdiger","family":"Sch\u00fcre","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Hospital of Goethe University Frankfurt , 60528 Frankfurt am Main , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juri-Alexander","family":"Witt","sequence":"additional","affiliation":[{"name":"Clinic for Epileptology, University Hospital of Bonn , 53127 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Reimers","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, Section for Translational Epilepsy Research, University Hospital of Bonn , 53127 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Elger","sequence":"additional","affiliation":[{"name":"Clinic for Neurology and Competence Center for Epilepsy, Beta Klinik Bonn GmbH , 53227 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Schramm","sequence":"additional","affiliation":[{"name":"Medical Faculty, University Medical Center Bonn , 53127 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert J","family":"Becker","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, Section for Translational Epilepsy Research, University Hospital of Bonn , 53127 Bonn , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Delev","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, RWTH Aachen University , 52074 Aachen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,18]]},"reference":[{"key":"2023021318535341400_awac293-B1","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1056\/NEJMoa1703784","article-title":"Histopathological findings in brain tissue obtained during epilepsy surgery","volume":"377","author":"Blumcke","year":"2017","journal-title":"N Engl J Med"},{"key":"2023021318535341400_awac293-B2","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1056\/NEJM200108023450501","article-title":"A randomized, controlled trial of surgery for temporal-lobe epilepsy","volume":"345","author":"Wiebe","year":"2001","journal-title":"N Engl J 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