Mesial temporal lobe epilepsy with hippocampal sclerosis

Introduction
Article section 1 of 15.  Next

By Jerome Engel Jr MD PhD

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. Dr. John Stern and Dr. Jerome Engel, both of the University of California in Los Angeles, discuss the diagnosis and treatment of this condition. 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 are excellent candidates for surgical treatment; 70% to 90% can become free of disabling seizures. Best results with respect to quality of life are obtained when surgical therapy is early in the course of the disorder.

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.