Calbindin D28K expression in relation to granule cell dispersion, mossy fibre sprouting and memory impairment in hippocampal sclerosis: a surgical and post mortem series.

Reorganisation of the dentate gyrus, including granule cell dispersion (GCD) and mossy fibre sprouting, typically accompany hippocampal sclerosis (HS) in temporal lobe epilepsy. Calbindin (CB) expression in granule cells increases during infancy, influences granule cell excitability, vulnerability to excitotoxicity in addition to important physiological functions in memory. Our aim was to study CB patterns in relation to dentate gyrus re-organisation, epilepsy history and memory function. Forty-five surgical cases and 11 post mortems were examined from patients with drug-resistant epilepsy in addition to three post mortem controls. In the surgical cases, CB expression, and the degree of GCD and mossy fibre sprouting were measured. In post mortem cases, CB expression was assessed in relation to the pattern of HS along the rostral-caudal axis of the hippocampus, and compared to PM controls. Three patterns were identified. In Group 1 (40%), the most dispersed granule cells were CB-positive and basal cells negative imitating developmental patterns. In Group 2 (47%), normal CB expression was retained and in Group 3 (13%), CB was predominantly lost in granule cells. These patterns correlated with GCD, the presence of mossy fibre sprouting and the pattern of HS. Group 1 was associated with early onset of seizures but not independently predictive of outcome. In post mortem cases, altered CB expression lateralised to the side of HS and persisted despite seizure remission in some patients. No significant correlation between CB expression and memory function was identified. CB expression patterns in HS may indicate developmental dysmaturation and are associated with the extent of GCD and mossy fibre sprouting in HS. The functional significance of CB loss, in terms of epileptogenesis and effects on memory, remain uncertain.