Mesial temporal lobe epilepsy with hippocampal sclerosis

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By John M Stern MD

Mesial temporal lobe epilepsy (MTLE) is also known as or subsumes Temporal lobe epilepsy, Limbic epilepsy, Psychomotor epilepsy, and Complex partial seizures.

Mesial temporal lobe epilepsy is the most prevalent form of epilepsy and among the most refractory to medical treatment. Hippocampal sclerosis is the usual pathological substrate, but other lesions in mesial temporal structures give rise to the same electroclinical syndrome. Although the etiology of hippocampal sclerosis and the natural history of mesial temporal lobe epilepsy are poorly understood, when seizures persist after a trial of first line medications and interfere with daily living, referral to an epilepsy center is important. Patients with mesial temporal lobe epilepsy often are excellent candidates for surgical treatment, with 70% to 90% becoming free of disabling seizures after treatment. Best results with respect to quality of life are obtained when surgical therapy is soon after failure of medications.

Key points

  • Temporal lobe epilepsy with hippocampal sclerosis (TLE-HS) is a common form of epilepsy.
  • Temporal lobe epilepsy with hippocampal sclerosis often is progressive with worsening seizures, cognitive function, and depression.
  • When medications fail to fully control seizures, resective surgery can be highly effective.



In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited