Mtle is the most common type of epilepsy and is often characterized by the sense of an aura immediately preceding the seizure. Effects of surgical targeting in laser interstitial thermal therapy for mesial temporal lobe epilepsy. Bilateral mesial temporal lobe epilepsy how is bilateral mesial temporal lobe epilepsy abbreviated. 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.
This paper improves the lateralization identification of the epileptogenic hippocampus accuracy in mesial temporal lobe epilepsy mtle. It is not akin to a temporal lobectomy, which is routinely performed for trauma or tumor surgery. Temporal lobe epilepsy with hippocampal sclerosis tlehs, the most frequent epilepsy syndrome, is generally refractory to antiepileptic drugs. Temporal lobe epilepsy caused by mesial temporal sclerosis. Bilateral mesial temporal lobe epilepsy how is bilateral. 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. Temporal lobe epilepsy with mts is one of the most common types of drugresistant epilepsy referred for epilepsy surgery. Temporal lobe epilepsy with hippocampal sclerosis tlehs, the most frequent epilepsy syndrome. We appreciate the thoughtful comments by schofield and nielsen regarding our investigation of the neuropsychological features of the syndrome of mtle. Loss of awareness occurs during a focal dyscognitive seizure when the seizure spreads to involve both temporal lobes. We present the electroclinical features, treatment, and evolution of patients with mesial temporal lobe epilepsy with hippocampal sclerosis mtlehs. 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. Hermann et al 1 recently identified the neuropsychological features of the syndrome of mesial temporal lobe epilepsy mtle.
Seizure freedom from temporal lobe epilepsy with mesial. Unilateral mesial temporal lobe epilepsy how is unilateral. Despite the strong association between epilepsy and psychiatric comorbidities, few biological substrates are currently described. Familial mesial temporal lobe epilepsy pdf paperity. Temporal lobe epilepsy is classified as a type of focal or partial seizure epilepsy. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. On the other hand, it is an often unrecognized cause of cognitive decline, typically presenting with severe memory loss. In young individuals, mesial temporal sclerosis is commonly recognized with temporal lobe epilepsy tle. Mesial temporal lobe epilepsy with hippocampal sclerosis. The causes of tle include mesial temporal sclerosis, traumatic brain injury, brain infections. Nevertheless, 40% of tle cases are refractory to medical treatment. Seizure precipitants and inhibiting factors in mesial temporal lobe epilepsy. A classical example of a surgically curable epilepsy syndrome is mesial temporal lobe epilepsy with about 7080% of patients becoming free of seizures after. Mesial temporal lobe epilepsy an overview sciencedirect topics.
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. 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. Neuroananatomical correlates of cognitive phenotypes in. Mesial temporal lobe epilepsy jama neurology jama network. Mtle with mts is the most surgically amenable epilepsy diagnosis and the results of epilepsy surgery are clearly superior. The first habitual seizures usually occur in late childhood or early adolescence.
Radiosurgery for medial temporal lobe epilepsy resulting from. Conventional open temporal lobectomy surgery may also be pursued if the initial radiosurgical. Jul 22, 2015 imaging in mesial temporal epilespy 1. Temporal lobe epilepsy is a predisposing factor for sleep apnea. Mesial temporal lobe epilepsy texas childrens hospital. The most common organic substrate for mtle is mesial temporal sclerosis mts. 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. Two pediatric cases treated successfully with tumor removal alone are presented. Mesial temporal lobe epilepsy an overview of surgical techniques. The onset of mesial temporal lobe epilepsy mtle varies, and it can emerge during infancy through the third decade of life. Mesial temporal lobe epilepsy mtle affects the inner part of the temporal lobe manifesting in the hippocampus, parahippocampal gyrus and the amygdala. Effects of chronic temporal lobe epilepsy on memory functions.
Mesial temporal lobe epilepsy mtle, one of the most common types of. Mesial temporal lobe epilepsy mtle, the most common epilepsy in adults, is generally intractable and is suspected to be the result of. 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 tle is divided into two categories. 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.
In our view, this means that the neuropsychology of epilepsy. The term temporal lobe epilepsy tle was included in the classification of the ilae in. Antiseizure medications approved for focal epilepsy are the firstline treatment. 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. Previous research characterized three cognitive phenotypes in temporal lobe epilepsy. T emporal lobe epilepsy tle is the most common form of focal epilepsy, accounting for the vast majority of partial seizures. In temporal lobe epilepsy tle seizures could originate in the medial or lateral. Mesial temporal lobe epilepsy mtle syndrome is an entity in which the most predominant seizures are originated in limbic areas of the mesial.
Pdf epilepsia do lobo temporal mesial associada a esclerose. Tell a friend about us, add a link to this page, or visit the webmasters page for free fun content. Electroencephalography in mesial temporal lobe epilepsy. Mts is usually a progressive disorder and seizures initially controlled with antiepileptic drugs can later become intractable in 6090% 16, 17. People with drugresistant medial temporal lobe epilepsy have a higher risk for memory and. 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. 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. 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.
Bilateral mesial temporal lobe epilepsy listed as bmtle. The most common form of partial epilepsy, temporal lobe epilepsy remains a mystery regarding cause and effective seizure treatment methods. Mesial temporal lobe epilepsy mtle is the most frequent form of partial epilepsy and has been considered a major medical. Although seizures in mtle heavily involve the temporal lobes, it is now clear that there are more anatomically widespread functional disturbances 3. About onethird of patients with tle may become resistant to medical therapy and require surgical treatment. What is the best target for ablation of mesial temporal lobe. Specific restingstate brain networks in mesial temporal lobe. Seizures typically occur during infancy and childhood and disappear for several years before they return in adolescence. Article information, pdf download for what is the best target for ablation of mesial temporal. Clinical, genetic, and mr characteristics of 68 patients with familial mesial temporal lobe epilepsy mtle were analysed at the university of campinasunicamp, brazil. In these cases, prior counseling of the patient and the family regarding the extent of resection and the resultant seizure outcome is paramount.
Typical unilateral mtle is associated with good outcomes after corticoamygdalohippocampectomy cah. 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. Surgical treatment for mesial temporal lobe epilepsy. Very longterm outcome of nonsurgically treated patients with. Mesial temporal lobe epilepsy with psychiatric comorbidities. Temporal lobe epilepsy in patients with nonlesional mri and. Surgery for mesial temporal lobe requires an elaborate understanding of the anatomy of mesial temporal lobe structures. Often a strong family history of epilepsy is present. To properly evaluate magnetic resonance imaging mri scans of the mesial temporal region, its specific human morphology duvernoy, 1988 should be well understood. Download these forms to help record and describe seizures. The reason given for the selection of nonsurgical treatment was also documented. Mesial temporal lobe epilepsy mtle is the most common form of partial epilepsy in.
Mesial temporal lobe epilepsyreply jama neurology jama. Mtle is characterized by epileptic activity arising from the mesial temporal region where there are neuropathological changes. Hippocampal sclerosis is the most common cause of pharmacoresistant epilepsy amenable for surgical treatment and seizure control. 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.
Mesial temporal lobe epilepsy resulting from hippocampal sclerosis. Mesial temporal lobe epilepsy with childhood febrile seizure. Symptoms of anxiety and depression in schoolaged children with active epilepsy. Epidemiology of temporal lobe epilepsy canadian journal of. Although their neuropsychological battery was comprehensive, they neglected to adequately define certain constructs of cognition.
Surgical considerations in mesial temporal lobe epilepsy surgery. Of these, mesial temporal lobe epilepsy mtle defines the majority, accounting for 6075 % of epilepsy patients undergoing surgery 3. Mesial temporal lobe epilepsy an overview of surgical. Improved cerebral function in mesial temporal lobe epilepsy. 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. Mesial temporal lobe epilepsy mtle with hippocampal sclerosis is the most common localizationrelated epilepsy in adults. It can be sporadic, usually with positive family history, or it can present with clear familial recurrence 2. Temporal lobe epilepsy tle is a chronic disorder of the nervous system characterized by. Temporal lobe epilepsy definition of temporal lobe epilepsy. Use of antiepileptic drugs during pregnancy and lactation.
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