The present study was performed to clarify the surgical outcomes and pathology of ae. Top meningioma treatment neurological surgery nspc. Histological classification of mesial temporal sclerosis. Fast fluidattenuated inversion recovery flair compared with t2weighted spinecho in the magnetic resonance diagnosis of mesial temporal sclerosis investigative radiology, vol. Mesial temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated with certain brain injuries. Mesial temporal sclerosis mesial temporal sclerosis, also known as hippocampal sclerosis, is the most common cause of temporal lobe epilepsy found at surgery. Top meningioma treatment neurological surgery long. Snyder1 1department of comparative pathobiology, purdue university, west lafayette, indiana, usa.
Pathogenetic mechanisms underlying this distinct hippocampal pathology remains undetermined. I started seeing a new neurologist who immediately said he was going to find out the cause, or do is best to. Loss of digitations of the hippocampal head on highresolution fast spinecho mr. Cell loss might involve sectors ca1 and ca4, ca4 alone, or ca1 to ca4. In vivo mapping of hippocampal subfields in mesial temporal. A wide spectrum of neuropathological changes was recorded in 98 specimens. A grading system for mesial temporal pathology hippocampal.
A peak correlation was observed in the ipsilateral perirhinal cortex. Unrelated paired associate scores, obtained from 27 patients with left mesial tle emanating from unilateral mesial temporal sclerosis mts, were regressed on resting glucose uptake in a whole brain 18 ffluorodeoxyglucose pet study weintrob et al. Secondary generalisation is much less common than in extra temporal lobe epilepsy. Well im still waiting on the eeg but my mri shows left mesial temporal sclerosis. Amygdalohippocampectomy is a wellestablished, standard surgery for medically intractable mesial temporal lobe epilepsy mtle. Features of mesial temporal sclerosis in a 32 year old man, who presented with intractable complex partial seizures of right temporal origin of years duration, are described. Patients often complain of poor memory for recent events, and this may get worse as the epilepsy continues. Brain damage from traumatic injury, infection, a brain tumor, a lack of oxygen to the brain, or uncontrolled seizures is thought to cause the scar tissue to form, particularly in the. Mesial temporal sclerosis and epilepsy health science journals. Mesial temporal sclerosis is a specific pattern of hippocampal neuron cell loss. Mesial temporal sclerosis mts is the most recognized wnding in drug resistant, chronic temporal lobe epilepsies 5. Pdf neuropathology of temporal lobe epilepsy researchgate. Search for a doctor by neurological surgery at columbia. While diffusion tensor imaging dti has been extensively used to infer microstructural characteristics of cerebral white matter in human conditions, correlations between human in vivo dti and histology have not been performed.
Pdf childhood mesial temporal sclerosis researchgate. The ilae classification of hs in patients with tle. Temporal lobe epilepsy with mesial temporal sclerosis. May 14, 2014 hippocampal sclerosis hs is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy mtle. The complete disconnection of the epileptogenic neural networks in the mesial temporal lobe determines the success of resective surgery. S nyder1 1department of comparative pathobiology, purdue university, west lafayette, in 47907, usa.
The miracle on fort washington avenue aneurysm surgery is a personal choice, says dr. A sign of mesial temporal sclerosis article pdf available in american journal of neuroradiology 193. Mts, hippocampal sclerosis hs, ammon horn sclerosis. Neuropathological features of mesial temporal sclerosis. Mesial temporal sclerosis mts is the most recognized finding in drug.
Over the past decades, there have been various attempts to classify the variants of hippocampal neuronal cell loss in relation to postoperative outcome. Hippocampal sclerosis mesial temporal sclerosis mts needs consideraton with clinical and eeg correlation. The most commonly found injury in adults is mesial temporal sclerosis mts 2,3. Mesial temporal sclerosis mts, also commonly referred to as hippocampal sclerosis, is the most common association with intractable temporal lobe epilepsy tle 2,3,5. Limbic system abnormalities associated with mesial. We therefore prefer the simpler term mesial temporal sclerosis mts because the sclerotic process usually involves other structures, such as the amygdala and uncus, as well as the hippocampus, and because the term which has since been adopted by others is purely descriptive without etiological or functional implications 8 figure. The term hippocampal sclerosis was originally used to describe a shrunken and hardened hippocampus, which histologically displayed neuronal loss and glial proliferation. Mesial temporal sclerosis hard seahorses and shrunken. Surgical treatment of drugresistant epilepsy due to. Pathogenesis, induced rodent models and lesions alok k. Mesial temporal sclerosis mts is a common pathologic finding in patients with.
It is seen in up to 65% of autopsy studies, although significantly less on imaging. In the brains diagnosed with mesial temporal sclerosis mts, these abnormalities involved not only the hippocampus but also other structures of the limbic system and medial temporal lobe. The 20 international league against epilepsy ilae classification segregates hs into typical type 1 and atypical type 2 and 3 groups, based on the. Little is known about the epidemiology of tle, because it requires advanced neuroimaging, positive eeg, and appropriate clinical semiology to confirm the. Mesial temporal lobe epilepsy mtle is the most common form of epilepsy in adults. The term ammons horn sclerosis first coined by sommer in 1880 is often used synonymous with hs. Many of these changes are evident at magnetic resonance imaging.
Manchester triage system mesial temporal sclerosis modified trichrome stain mouse thyroid stimulator muir torre syndrome sclerosis sklerosis gr. Fifteen patients 35% had a history of prolonged febrile convulsions pfc in early childhood. Detection of hippocampal pathology in intractable partial epilepsy. Mri scan commonly displays increased t2 signal and hippocampal atrophy. Temporal profile of clinical signs and histopathologic changes in an f344 rat model of kainic acidinduced mesial temporal lobe epilepsy alok k. In children with temporal lobe epilepsy, mts is considered an infrequent etiology 4,5, but with the advances in neuroimaging, mts which was thought to. Jun 18, 2015 the condition called mesial temporal sclerosis is closely related to temporal lobe epilepsy, a type of partial focal epilepsy in which the seizure initiation point can be identified within the temporal lobe of the brain. In vivo diffusion tensor imaging and histopathology of the. Identification of mesial temporal sclerosis is critical in the evaluation of individuals with temporal lobe epilepsy. Mesial temporal lobe epilepsy an overview of surgical. Tailored resection strategies including selective amygdalahippocampectomy are established treatment modalities and over a favourable outcome with up to 80% postoperative seizure freedom within the wrst 2 years 1, 2, 14, 17.
Lesional mesial temporal lobe epilepsy and limited. International consensus classification of hippocampal sclerosis in. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. Simple focal seizures are the initial nonfebrile seizures followed by. Hippocampal sclerosis hs is a common pathology encountered in mesial temporal lobe epilepsy mtle as well as other epilepsy syndromes and in both surgical and postmortem practice.
Hippocampal sclerosis hs is a common pathology encountered in mesial temporal lobe epilepsy mtle as well as other epilepsy syndromes. Temporal profile of clinical signs and histopathologic. Epilepsy is a cns disorder affecting about 70 million people worldwide. Pdf mesial temporal sclerosis and epilepsya case report. Hippocampal sclerosis hs is the most frequent histopathology. Epileptic seizures of the temporal lobe constitute the most frequent presentation of drugresistant epilepsy which satisfactorily responds to surgical treatment 1. However, in the case of mtle without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with. In the earliest descriptions of hippocampal sclerosis hs in temporal lobe resection specimens, it was recognized that diffuse and disseminated lesions may be present in association with this pathology involving the uncus, amygdala, and lateral temporal neocortex. Little is known about the epidemiology of tle, because it requires advanced neuroimaging, positive eeg, and appropriate clinical semiology to confirm the diagnosis. The term mts is used here as a qualita tive and descriptive the pathologist was unaware of whether or not the patients had a history of pfc. Temporal lobe epilepsy tle patients with mesial temporal sclerosis mts have abnormal dti parameters of the fimbriafornix relative to tle patients without mts.
Social perception in mesial temporal lobe epilepsy. Hippocampal sclerosis and atrophy were found in nine 25. Introduction partial seizures of temporal lobe origin are common in both children and adults. Clinical examination revealed no neurological deficit. It is found in approximately 5075% of temporal lobe resections made for medically intractable limbic epilepsy honavar and meldrum, 1997. In the present study, we investigated the relationship between this technique applied to conventional t1. A seizure associated neuronal loss and gliosis in hippocampus. Mri evidence of mesial temporal sclerosis in subjects. Pdf loss of digitations of the hippocampal head on high. Hippocampal sclerosis is a very common feature of temporal lobe epilepsy complex partial seizures or limbic epilepsy. Jul 01, 2014 hippocampal sclerosis hs is a common pathology encountered in mesial temporal lobe epilepsy mtle as well as other epilepsy syndromes and in both surgical and postmortem practice.
Mesial temporal sclerosis radiology reference article. Hippocampal sclerosis, temporal lobe sclerosis, and amygdaloid sclerosis. Neurological and mental state usually normal prior to seizure onset. The 20 international league against epilepsy ilae classification segregates hs into typical type 1 and atypical type 2 and 3 groups, based on the histological patterns of subfield neuronal loss and gliosis. Mesial temporal sclerosis mts, or hippocampal sclerosis hs, is the most common pathology in adults with drugrefractory temporal lobe epilepsy tle. The prevalence of mesial temporal sclerosis among all children having magnetic resonance imaging brain studies performed for seizures was much higher, being 12. Of 738 patients operated for tle, 78 patients underwent limited resections for lesional mtle 19902000. Hippocampal specimens of pharmacoresistant mtle patients that underwent epilepsy surgery for seizure control reveal the characteristic pattern of segmental neuronal cell loss and concomitant astrogliosis. Bilateral mesial temporal sclerosis radiology case. Mesial temporal sclerosis mts is the most common histopathology occurring in patients with drugresistant temporal lobe epilepsy. Improved detection of subtle mesial temporal sclerosis. Early childhood prolonged febrile convulsions, atrophy and. Temporal lobe sclerosis associated with hippocampal.
The neuropathological features of temporal lobe epilepsy were studied utilising 100 consecutive surgical specimens from patients with medically refractory complex partial seizures. International consensus classification of hippocampal. Epilepsies associated with hippocampal sclerosis springerlink. Reviewing 178 cases of mesial temporal lobe epilepsy, blumcke and. Mesial temporal sclerosis mts is a term coined by falconer and colleagues 1 to describe a lesion characterized by neuronal loss and gliosis involving principally the hippocampus and the amygdala, or both, but occasionally extending to other mesial temporal structures entorhinal cortex and parahippocampal gyrus or even throughout the temporal lobe. Hippocampal sclerosis, also known as ammon horn sclerosis, is a common pathologic finding in surgical specimens from patients with tle. A new clinicopathological classiwcation system for mesial. Hippocampal sclerosis hs is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy mtle. Madisons epilepsy cure meet the doctor video series complete.
To evaluate the influence of clinical, investigational, surgical, and histopathological factors on postoperative seizure relief in patients with mesial temporal lobe epilepsy mtle due to lesions other than ammonshornsclerosis ahs. Mesial temporal sclerosis mesial temporal sclerosis, also known as hippocampal sclerosis, is the most common cause. Partialonset epilepsies account for about 60% of all adult epilepsy cases, and temporal lobe epilepsy tle is the most common type of partial epilepsy referred for epilepsy surgery and often refractory to antiepileptic drugs aeds. However, most reports related to ae have referred to imaging studies, and there have been few reports regarding surgical and pathological findings. Clinical manifestations preexisting complex febrile convulsions are common. Mesial temporal sclerosis definition of mesial temporal. Yet, temporal lobe epilepsy is not a homogeneous cerebral disorder. Mesial temporal sclerosis mts is herein defined as hs plus changes in other structures of the mesial part of the temporal lobe such as amygdala and entorhinal cortex as evidenced by imaging findings or histopathology. Secondary generalisation is much less common than in extratemporal lobe epilepsy. Although seizures may arise from any area of the temporal lobe, in the majority of patients seizures arise in mesial structures i. Objective amygdala enlargement ae has been suggested to be a subtype of mesial temporal lobe epilepsy mtle. Fiftyeight specimens showed features of ammons horn sclerosis. The term mesial temporal sclerosis as an alternative to hs was introduced in recognition of the. The causes of tle include mesial temporal sclerosis, traumatic brain injury, brain infections, such as encephalitis and meningitis, hypoxic brain injury, stroke, cerebral tumours, and genetic syndromes.
Feb 01, 2008 the term hippocampal sclerosis was originally used to describe a shrunken and hardened hippocampus, which histologically displayed neuronal loss and glial proliferation. Tailored resection strategies including selective amygdalahippocampectomy are established treatment modalities and offer a favourable outcome with up to 80% postoperative seizure freedom within the first 2 years 1, 2, 14, 17, 45, 47. Our aim was to assess the performance of fdaapproved software measures of hippocampal volume to identify mesial temporal sclerosis in patients with medically refractory temporal lobe epilepsy compared with the initial clinical interpretation of a. A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. A condition characterised by induration of the middle temporal lobe, associated with cortical dysplasia and intractable temporal lobe epilepsy. Of note is that 11 of our 12 cases of mesial temporal sclerosis had magnetic resonance imaging studies performed with the epilepsy protocol discussed above. Tle is the most common form of epilepsy with focal seizures. A new clinicopathological classification system for. Aetiology major cerebral trauma, infection, febrile illness in childhood. Effects of chronic temporal lobe epilepsy on memory functions. Associated hippocampal atrophy and gliosis is common. These alterations are mainly located in the hilus of the dentate gyrus and in the ca1 and ca3 pyramidal cell layers but all hippocampal regions may show neuronal cell loss to varying degrees.
He ordered a more detailed mri and a 72 hour ambulatory video eeg. Mesial temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated. A new clinicopathological classification system for mesial temporal. Anterior temporal lobectomy for older adults with mesial. Mesial temporal sclerosis mts is the most common cause of medically refractory temporal lobe epilepsy tle. Amnesia is the rule for the blank spell and the automatism.
No lesions are observed in ptle, whereas in the 70% of mtle patients with hs aka mesial temporal sclerosis or ammons horn sclerosis lesions include neuronal degeneration, astrogliosis babb and. Temporal lobe epilepsy tle is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. Mesial temporal sclerosis mts is the most recognized finding in drug resistant, chronic temporal lobe epilepsies. The etiology of mesial temporal sclerosis remains hotly debated. Vagal nerve stimulation is a minimally invasive mesial temporal sclerosis treatment that employs an implanted stimulator to deliver electric impulses to an electrode on the vagal nerve in the neck via a lead wire implanted under the skin. The 20 international league against epilepsy ilae classi. As mtle is often drug resistant, the treatment of choice is surgery of the epileptogenic focus. Magnetic resonance imaging detection of mesial temporal. The pathology most commonly present in cases of idiopathic temporal lobe epilepsy is most obvious. Mesial temporal sclerosis mts is the most common pathological finding in temporal lobe epilepsy tle, but the relationship between mts. Surgery for amygdala enlargement with mesial temporal lobe. The purpose of this study was to estimate the prevalence of mts by mri in the general population. We performed mri volumetric measurements of the amygdala am and hippocampal formation hf in a group of 43 patients with temporal lobe epilepsy not controlled by optimal drug treatment.
I dont go back to see him until may 5 to get a better explanation. This fact is probably best reflected by the lasting discussion as to whether tle with hippocampal sclerosis can be considered to be a disease or a syndrome wieser h. Recent findings suggest a developmental malformation of. Jan 20, 2010 while diffusion tensor imaging dti has been extensively used to infer microstructural characteristics of cerebral white matter in human conditions, correlations between human in vivo dti and histology have not been performed. Auditory aura s usually manifest as auditory hallucination such as sounds. Mesial temporal hippocampal sclerosis mesial temporal sclerosis syn.