Commentary on the 1st International Summer School for Neuropathology and Epilepsy Surgery (INES 2013) held in Erlangen, Germany, September 16-20, 2013

Abstract

Epilepsy surgery is increasingly available as a successful treatment option in patients with drug-resistant focal epilepsies when associated with distinct brain lesions. Reliable neuropathologic work-up of epilepsy-associated brain lesions represents, therefore, an important diagnostic tool in clinical epileptology, and the International League Against Epilepsy's international classification of epilepsies recognizes a large spectrum of neuropathologic substrates as potential predictors of each patient's disease progression and treatment response. However, histopathologic standards are not yet available for all different lesions encountered in patients with epilepsy, nor are they very well accepted or disseminated among the diagnostic pathology community. In addition, the microscopic diagnosis of epilepsy-related surgical brain specimens remains challenging due to the broad spectrum of disease variants. The European Commission of the International League Against Epilepsy (ILAE-CEA) launched a first neuropathology teaching course aimed at colleagues who are engaged in the diagnostic evaluation of patients with drug-resistant focal epilepsy. Thirty-seven colleagues from 25 nations participated at this first INES summer school in Erlangen, Germany (Fig. 1A). Most participants had a medical training record in pathology or neuropathology, although some had their background also in neurology, neurosurgery, neuroradiology, neuropsychology, or neurosciences. This multidisciplinary group composition fostered fruitful discussions during the week that were considered most helpful to appreciate the value but also limitations of histopathology diagnosis in epilepsy surgery. The group was trained during 5 days by six distinguished tutors (Dr. Eleonora Aronica, Amsterdam; Dr. Albert Becker, Bonn; Dr. Ingmar Blumcke, Erlangen; Dr. Hajime Miyata, Akita; Dr. Harvey Sarnat, Calgary; and Dr. Maria Thom, London). Each tutor mentored his/her own group of six to seven students, helping them to microscopically review and discuss a series of 112 glass slides obtained from 31 surgical specimens selected to cover the large spectrum of epilepsy-related brain lesions and their variants, that is, the new ILAE classification of hippocampal sclerosis (first day), epileptic encephalitis and vascular disorders (second day), long-term epilepsy–associated brain tumors (third day), and the ILAE classification of focal cortical dysplasia as well as other malformations of cortical development (fourth and fifth days). This valuable series of histopathologic glass slides was prepared by the course organizers in Erlangen to offer each student free access to microscopic review and to familiarize with helpful and recommended special stainings, including a large panel of immunohistochemistry. All information was made available also by a special course booklet summarizing case presentation, protocols for neuropathologic workup in epilepsy surgery, as well as several histopathologic review articles introducing all major entities of epileptogenic brain lesions. We also invited distinguished speakers experienced in the field of clinical epileptology (Dr. Eugen Trinka, Salzburg; Dr. Christian Bien, Bielefeld; Dr. Karl Rössler, Erlangen; Dr. Hans Holthausen, Vogtareuth; and Dr. Fernando Cendes, Campinas), who always started the day's teaching program with a topic-related plenary lecture introducing the principles of adult or childhood epileptology, modern imaging techniques, or neurosurgical procedures. In addition to these practical teaching sessions, the interdisciplinary discussion and training environment in the microscope lecture room offered an encouraging spirit to foster clinical and scientific interest in the field of surgical neuropathology. The students' evaluation achieved exceptional rating scales, which support the course's structure with enough room and space for face-to-face teaching, as well as group discussions during case presentation and plenary lectures. Not to forget, our social events were very well anticipated and regarded helpful for building professional networks. Scholarships were made available from the International Society of Neuropathology (ISN, Fig. 1C) and International Brain Research Organization (IBRO, Fig. 1B), which allowed also participants from low-income countries to attend this course. CEA-ILEA support will be available also for next year's second INES in Erlangen. The dates will be announced on the course website at www.epilepsie-register.de or available at personal request from the course director ([email protected]). Both faculty and participants were confident that this course was most helpful to train in this rapidly emerging discipline with its new diagnostic classification schemes and many still ill-defined disease categories, covering a huge spectrum of brain malformations, inflammatory disease, degeneration, and tumors. Looking forward to meeting you next year in Erlangen! None of the authors have any conflicts to declare. INES 2013 was financially supported by ILAE-CEA (Commission on European Affairs of the Intl League against Epilepsy), IBRO (International Brain Research Organization), ISN (International Society of Neuropathology) and Roche Diagnostics Deutschland GmbH (Mannheim, Germany). 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