Mtle is the most common type of epilepsy and is often characterized by the sense of an aura immediately preceding the seizure. We appreciate the thoughtful comments by schofield and nielsen regarding our investigation of the neuropsychological features of the syndrome of mtle. It is not akin to a temporal lobectomy, which is routinely performed for trauma or tumor surgery. Mesial temporal lobe epilepsy an overview of surgical. Very longterm outcome of nonsurgically treated patients with. Seizures typically occur during infancy and childhood and disappear for several years before they return in adolescence.
This paper improves the lateralization identification of the epileptogenic hippocampus accuracy in mesial temporal lobe epilepsy mtle. The onset of mesial temporal lobe epilepsy mtle varies, and it can emerge during infancy through the third decade of life. In these cases, prior counseling of the patient and the family regarding the extent of resection and the resultant seizure outcome is paramount. Mesial temporal lobe epilepsy mtle is a common epilepsy type and is usually resistant to antiepileptic drugs. Mesial temporal lobe epilepsy with childhood febrile seizure.
Seizure freedom from temporal lobe epilepsy with mesial. The causes of tle include mesial temporal sclerosis, traumatic brain injury, brain infections. Update on temporal lobe epilepsy a special issue journal published by hindawi temporal lobe epilepsy tle is the most common form of focal epilepsy that may secondarily generalize. Electroencephalography in mesial temporal lobe epilepsy.
Temporal lobe epilepsy tle is the most common form of epilepsy, and most patients with this diagnosis have mesial temporal lobe epilepsy mtle with hippocampal sclerosis. Mesial temporal lobe epilepsy with hippocampal sclerosis. The reason given for the selection of nonsurgical treatment was also documented. Antiseizure medications approved for focal epilepsy are the firstline treatment. Mesial temporal lobe epilepsy with psychiatric comorbidities. Although the theory is controversial, there is a link between febrile seizures seizures coinciding with episodes of fever in young children and subsequent temporal lobe epilepsy, at least epidemiologically. Of these, mesial temporal lobe epilepsy mtle defines the majority, accounting for 6075 % of epilepsy patients undergoing surgery 3. It can be sporadic, usually with positive family history, or it can present with clear familial recurrence 2. The most common organic substrate for mtle is mesial temporal sclerosis mts. Temporal lobe epilepsy in patients with nonlesional mri and. In the surgical treatment of temporal lobe epilepsy with mesial temporal lobe tumor, whether to remove the hippocampus aiming for a better seizure outcome in addition to removing the tumor is a dilemma.
In patients with this kind of epilepsy, usually one of the brains hippocampi is the focus of the epileptic seizures, and resection of the seizure focus is the ultimate treatment to control or reduce the. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. Temporal lobe epilepsy tle is a chronic disorder of the nervous system characterized by. This study aims to determine whether there are important clinicoelectrical differences between patients with temporal lobe epilepsy tle secondary to mesial temporal sclerosis mts and those with tle secondary to a discrete temporal neocortical lesion nl. Mesial temporal lobe epilepsy mtle is the most common form of partial epilepsy in adults 1, and it is estimated that it represents about 40% of all epilepsies in this age range.
Neuroananatomical correlates of cognitive phenotypes in. Unilateral mesial temporal lobe epilepsy how is unilateral. To properly evaluate magnetic resonance imaging mri scans of the mesial temporal region, its specific human morphology duvernoy, 1988 should be well understood. Familial mesial temporal lobe epilepsy pdf paperity. Mtle with mts is the most surgically amenable epilepsy diagnosis and the results of epilepsy surgery are clearly superior.
Surgical treatment for mesial temporal lobe epilepsy. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy. Article information, pdf download for what is the best target for ablation of mesial temporal. What is the best target for ablation of mesial temporal lobe. T emporal lobe epilepsy tle is the most common form of focal epilepsy, accounting for the vast majority of partial seizures. Jun 05, 2015 temporal lobe epilepsy tle may be simple focal seizures without loss of awareness with or without aura or focal dyscognitive seizures with loss of awareness. Temporal lobe epilepsy is a predisposing factor for sleep apnea. Surgery for mesial temporal lobe requires an elaborate understanding of the anatomy of mesial temporal lobe structures. Bilateral mesial temporal lobe epilepsy how is bilateral. Mtle is characterized by epileptic activity arising from the mesial temporal region where there are neuropathological changes. Mesial temporal lobe epilepsy mtle is the most frequent form of partial epilepsy and has been considered a major medical. Temporal lobe epilepsy with mts is one of the most common types of drugresistant epilepsy referred for epilepsy surgery. Nevertheless, 40% of tle cases are refractory to medical treatment.
Mesial temporal lobe epilepsy mtle is the most common form of partial epilepsy in. Mesial temporal lobe epilepsy mtle affects the inner part of the temporal lobe manifesting in the hippocampus, parahippocampal gyrus and the amygdala. Download these forms to help record and describe seizures. Mesial temporal lobe epilepsy texas childrens hospital. Temporal lobe epilepsy is classified as a type of focal or partial seizure epilepsy. On the other hand, it is an often unrecognized cause of cognitive decline, typically presenting with severe memory loss.
Hippocampal sclerosis is the most common cause of pharmacoresistant epilepsy amenable for surgical treatment and seizure control. We present the electroclinical features, treatment, and evolution of patients with mesial temporal lobe epilepsy with hippocampal sclerosis mtlehs. Clinical, genetic, and mr characteristics of 68 patients with familial mesial temporal lobe epilepsy mtle were analysed at the university of campinasunicamp, brazil. Mesial temporal lobe epilepsy jama neurology jama network. The term temporal lobe epilepsy tle was included in the classification of the ilae in. Two pediatric cases treated successfully with tumor removal alone are presented. Mesial temporal lobe epilepsy an overview sciencedirect topics. Specific restingstate brain networks in mesial temporal lobe. The first habitual seizures usually occur in late childhood or early adolescence. About onethird of patients with tle may become resistant to medical therapy and require surgical treatment. Effects of chronic temporal lobe epilepsy on memory functions. In young individuals, mesial temporal sclerosis is commonly recognized with temporal lobe epilepsy tle.
Mesial temporal sclerosis mts is the most common pathological substrate of temporal lobe epilepsy tle 1. Surgical considerations in mesial temporal lobe epilepsy surgery. Temporal lobe epilepsy definition of temporal lobe epilepsy. The most common form of partial epilepsy, temporal lobe epilepsy remains a mystery regarding cause and effective seizure treatment methods. Tell a friend about us, add a link to this page, or visit the webmasters page for free fun content. Mesial temporal lobe epilepsy mtle syndrome is an entity in which the most predominant seizures are originated in limbic areas of the mesial. Previous research characterized three cognitive phenotypes in temporal lobe epilepsy. Loss of awareness occurs during a focal dyscognitive seizure when the seizure spreads to involve both temporal lobes. Epilepsy arising in the medial temporal lobe mtle table 1 the commonest pathology underlying this type of epilepsy is hippocampal sclerosis3,4, and the entity of mesial temporal lobe epilepsy with hippocampal sclerosis mtle with hs is recognised as a distinctive constellation among the focal epilepsies5. Mts is usually a progressive disorder and seizures initially controlled with antiepileptic drugs can later become intractable in 6090% 16, 17. Temporal lobe epilepsy with hippocampal sclerosis tlehs, the most frequent epilepsy syndrome, is generally refractory to antiepileptic drugs.
Improved cerebral function in mesial temporal lobe epilepsy. Mesial temporal lobe epilepsyreply jama neurology jama. Mesial temporal lobe epilepsy an overview of surgical techniques. Temporal lobe epilepsy caused by mesial temporal sclerosis. Mesial temporal lobe epilepsy mtle, the most common epilepsy in adults, is generally intractable and is suspected to be the result of. Often a strong family history of epilepsy is present. Temporal lobe epilepsy tle is divided into two categories. In temporal lobe epilepsy tle seizures could originate in the medial or lateral.
The mesial temporal lobe, also known as the medial temporal lobe, is, as the name suggests, located on the medial aspect of the temporal lobe and is distinct from the rest of the lobe, which is composed of neocortex. Typical unilateral mtle is associated with good outcomes after corticoamygdalohippocampectomy cah. The hallmarks of mesial temporal lobe epilepsy mtle are typical simple partial aura and complex partial with a loss of consciousness seizures, which can develop into secondary generalized tonicclonic seizures. Mar 07, 2012 temporal lobe epilepsy with mesial temporal sclerosis usually presents between 610 years of age but can present from infancy to the 30s. A classical example of a surgically curable epilepsy syndrome is mesial temporal lobe epilepsy with about 7080% of patients becoming free of seizures after. Jul 22, 2015 imaging in mesial temporal epilespy 1. Radiosurgery for mesical temporal sclerosis mtsassociated medial temporal love epilepsy mtle is an attractive option because it is relatively noninvasive, with lower morbidity than major surgery. Use of antiepileptic drugs during pregnancy and lactation. Mesial temporal lobe epilepsy resulting from hippocampal sclerosis. Although seizures in mtle heavily involve the temporal lobes, it is now clear that there are more anatomically widespread functional disturbances 3. Despite the strong association between epilepsy and psychiatric comorbidities, few biological substrates are currently described.
Mesial temporal lobe epilepsy mtle with hippocampal sclerosis is the most common localizationrelated epilepsy in adults. Pdf epilepsia do lobo temporal mesial associada a esclerose. Temporal lobe epilepsy with hippocampal sclerosis tlehs, the most frequent epilepsy syndrome. Conventional open temporal lobectomy surgery may also be pursued if the initial radiosurgical. Hermann et al 1 recently identified the neuropsychological features of the syndrome of mesial temporal lobe epilepsy mtle. Seizure precipitants and inhibiting factors in mesial temporal lobe epilepsy.
Epidemiology of temporal lobe epilepsy canadian journal of. In our view, this means that the neuropsychology of epilepsy. Symptoms of anxiety and depression in schoolaged children with active epilepsy. People with drugresistant medial temporal lobe epilepsy have a higher risk for memory and. Bilateral mesial temporal lobe epilepsy listed as bmtle. Bilateral mesial temporal lobe epilepsy how is bilateral mesial temporal lobe epilepsy abbreviated. We have previously reported neuropathological alterations in mesial temporal lobe epilepsy mtle patients with major depression and psychosis that suggest a morphological and neurochemical basis for psychopathological symptoms. Jan 30, 2012 finally, recent data clearly show both that there is a fair degree of reorganization of these networks in patients with temporal lobe epilepsy tle and that even when seizures are exclusively in mesial temporal regions, there is more widespread anatomic and functional disturbance.770 229 1585 883 277 1503 156 1266 367 1561 555 1112 127 373 1501 96 818 1546 1007 779 1240 430 1438 1206 37 38 318 288 1283 642 432 1452 1234 70 830 1157 720 1078 1192 742 1172 1342 1256 861 279 633 991