Polyglucosan bodies and temporal lobe epilepsy: an incidental finding or more?

This study reports on histological findings in the temporal lobe of a 36-ye ar-old woman who underwent a right temporal lobectomy for pharmaco-resistan t complex partial seizures. Since surgery, the patient has remained seizure -free. The patient had an established diagnosis of right temporal robe epil epsy, based on video EEG recordings of seizures, MRI hippocampal atrophy, f ocal interictal hypometabolism on fluoro-desoxy-glucose, hypofixation of C- 11-flumazenil in PET studies, and ictal intracerebral recordings. Biopsies were studied under light- and electron microscopy. Histology showed diffuse distribution of a large number of polyglucosan bodies (PBs) in the whole r ight temporal lobe white matter. PBs were mostly confined to the perivascul ar areas and in subpial zones rarely and were observed in the most superfic ial cortical layers. There was some neuronal loss, especially in opercular zone T1. but no other histological lesion was found. Ultrastructurally, PBs were made of filamentous and amorphous material, and were found both in in tra-astrocytic processes and in axons. The presence of numerous PBs in the temporal lobe of patients with refractory temporal lobe epilepsy has been r eported in 3 patients in the literature. It raises the questions whether th is histological abnormality could be related to the epileptogenic process a s a cause or as a consequence.