simple partial seizures of the dj-vu or jamais-vu type; or including epigastric or psychic manifestations, followed by complex partial seizures characterized by staring and oral automatisms with or without superior limb automatisms or contralateral superior limb dystonia); c) HS was evident on MRI as signal hyperintensity within the hippocampus on T2-weighted or fluid-attenuated inversion-recovery (FLAIR) images, or as hippocampal atrophy on coronal T1-weighted images; d) patients who had not undergone surgical resection. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). MTLE accounts for almost 80% of all temporal lobe seizures. doi: 10.1101/cshperspect.a022426. Copyright: 2016 Kurita et al. PLoS ONE 11(7): Fishers exact test (two-tailed) was used to compare sex, side of HS, febrile seizures, GTCs, seizure frequency at the onset, the number of patients with epileptic psychosis, and the number who were surgical candidates after presurgical evaluation. Participants who do not need surgery or whose epilepsy cannot be treated surgically will follow up with a primary care physician or neurologist and will not need to return to the National Institutes of Health for this study. Clinical factors such as age, gender, lesion side, previous medical history, duration of illness, seizure frequency and IQ did not correlate to prognosis. Many people with MTS also suffer from other brain-related issues, a condition called co-morbidity. Other causes are related to viral infection and encephalitis, due to viruses such as human herpes virus type 6 (HHV-6), or to autoimmune disease where the immune system makes proteins that can attack the brain. Age at onset in patients with medically refractory temporal lobe epilepsy and mesial temporal sclerosis: impact on clinical manifestations and postsurgical outcome. Patient medical records were used to retrospectively study seizure frequency, various clinical factors, and social adjustment. PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US. Unable to load your collection due to an error, Unable to load your delegates due to an error. A surgical procedure called a temporal lobectomy is often effective, especially if only one side of the brain is affected. Would you like email updates of new search results? Patients with mesial temporal sclerosis on only one side of the brain usually have a better outcome than patients with bilateral mesial temporal sclerosis. Glutamate is a chemical vital to communication between brain cells, but. Rarely MTS can be detected in children during the first decade of life, but is not commonly found until adolescence. National Library of Medicine This part of the brain is responsible for multiple functions, including the regulation of emotions and memory. The average age of patients in Group 1 was older than Group 2 (p = 0.0468). For full functionality of this site, please enable JavaScript. This relationship represents a strong argument for the necessity of early medical treatment for TLE-HS. In a, that is not yet completely understood, nerve cells in the affected area are. 1 There are 2 forms of temporal lobe epilepsy: a common form with mesial temporal lobe symptoms and a rarer form with lateral temporal lobe symptoms. Expert epileptologists and neuroradiologists reviewed the MRI scans of each patient independently. Epileptic psychosis was defined as the presence of psychosis with hallucination-delusion, agitation, or aggression (so-called schizophrenia-like symptoms) during treatment for epilepsy. PLOS ONE promises fair, rigorous peer review, Epilepsia. The trigger event leading to seizure control was a change or increase in medication in 6 patients, first medication in 2 patients, a gradual reduction in 3 patients, and rare seizure from the onset in 1 patient. Your temporal lobe is the second-largest of your brain's five lobes. In Group 2, 12 of the 29 patients had seizures less than once per month, while the remaining 17 patients had more frequent seizures. PMC The clinical characteristics of the patients in each group are summarized in Table 1. However, some patients with TLE-HS still do not undergo surgery for various reasons, including medical (bilateral focus, psychiatric symptoms) or economic reasons, or sometimes simply out of respect for the patients wishes. Sex, duration of epilepsy, age of onset, laterality of HS, febrile seizures, and presence of GTCs were not significantly different between the groups. Conceived and designed the experiments: TK KS YT. Unable to load your collection due to an error, Unable to load your delegates due to an error. This result indicates that more seizure activity at onset was related to the difficulty of seizure control, a relationship that corresponded with the results of the preceding studies [19, 20]. Patients of Group 2 had taken a mean of 5.51.9 AEDs, versus 3.51.6 AEDs in Group 1 (p = 0.0024). The most common reason for the selection of non-surgical treatment was refusal of surgery (24 patients). eCollection 2020 Aug. Curr Neurol Neurosci Rep. 2020 Jul 14;20(9):41. doi: 10.1007/s11910-020-01065-z. Scarring of the hippocampus is the most common form; this condition is called hippocampal sclerosis. Mesial temporal sclerosis (MTS) is the most common association with intractable temporal lobe epilepsy (TLE) . National Library of Medicine Video electroencephalography monitoring to measure brain activity during normal activities within a 24-hour period. doi: 10.1684/epd.2007.0152. Patients who were seizure-free or had only aura were classified into Group 1; the others were classified into Group 2. Analyzed the data: TK KS. Patient records/information were anonymized and de-identified prior to analysis. Eighty-three patients with intractable partial epilepsy with MRI and electroencephalograph (EEG) abnormalities and seizure semiology consistent with temporal lobe epilepsy were identified. Its aetiology remains unclear but genetic factors are involved. Epub 2015 Feb 26. Keep a diary of your childs symptoms and be alert for seizure activity. In other cases, a genetic susceptibility can play a role as well especially in cases where family members have had similar seizures. Rev Neurol (Paris). 2005;46 Suppl 7:39-44. doi: 10.1111/j.1528-1167.2005.00306.x. and transmitted securely. If the first medication fails to control seizures, a second medication is typically tried. 1997, "Erkrankung des Ammon's horn als aetiologis ches moment der epilepsien", "Clinical and neuropathological characteristics of hippocampal sclerosis: a community-based study", "Seizure outcome and hippocampal atrophy in familial mesial temporal lobe epilepsy", "Febrile seizures and mesial temporal sclerosis", "Classic hippocampal sclerosis and hippocampal-onset epilepsy produced by a single "cryptic" episode of focal hippocampal excitation in awake rats", "Prevalence, laterality, and comorbidity of hippocampal sclerosis in an autopsy sample", "Ammon's Horn Sclerosis: A Maldevelopmental Disorder Associated with Temporal Lobe Epilepsy", "Defining Clinico-Neuropathological Subtypes of Mesial Temporal Lobe Epilepsy with hippocampal Sclerosis", "Hippocampal sclerosis in advanced age: clinical and pathological features", "Hippocampal sclerosis in Lewy body disease is a TDP-43 proteinopathy similar to FTLD-TDP Type A", https://en.wikipedia.org/w/index.php?title=Hippocampal_sclerosis&oldid=1146067893, This page was last edited on 22 March 2023, at 15:54. MTS may cause cognitive and behavioral symptoms as well as seizures. Bookshelf Multi-omic strategies applied to the study of pharmacoresistance in mesial temporal lobe epilepsy. It is seen in up to 65% of autopsy studies, although significantly less in imaging. in patients with mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) would improve surgical decision-making and post-operatory follow-up in this group of patients. The laser heats the region and destroys the area of scarring, and the probe is then removed. The investigators plan to enroll individuals with medial temporal lobe epilepsy undergoing surgical workup with clinically implanted intracranial electrodes. This retrospective study was approved by the independent ethics committee of Hokkaido University Hospital. In the cited study, most patients had uncomplicated epilepsies, and the authors did not investigate the relationship between holding a job and seizure outcomes. Ready for help? When scars form in the inner, or mesial, portion of the temporal lobe known as the hippocampus, the result is mesial temporal sclerosis. Epilepsy Res. A randomized, controlled trial of epilepsy surgery for patients with TLE-HS demonstrated a better outcome after surgery versus medical treatment [2,8]; indeed, the standard treatment plan for TLE-HS without seizure control by medication is surgical resection [9]. The subjects of previous reports were refractory cases being assessed for surgical treatment [2,3,7,8,11]. Those who undergo successful surgical treatment with temporal lobectomy or amygdalohippocampectomy may become seizure free. Many people whose seizures do not respond to medication will respond to surgical treatment, relieving seizures completely or almost completely in one-half to two-thirds of patients who qualify for surgery. Consult your doctor right away when you see any of the disorders warning signs. MTLE with hippocampal sclerosis in adult as a syndrome. Accessibility 2008;29:8237. If MTS involves both sides of the brain then surgical resection is often not possible, as one cannot remove both temporal lobes due to memory and other functional concerns. Toru Horinouchi, As cells in the temporal lobe die, the symptoms of MTS result. This site needs JavaScript to work properly. MeSH This site needs JavaScript to work properly. In this study, we hypothesized that mesial temporal sclerosis (MTS) was less common in patients who had undergone surgery for intractable pediatric TLE than in adult series. The study was carried out to determine the clinical risk factors affecting prognosis. The study will include approximately 150 adult patients with drug-resistant MTLE treated at selected epilepsy centers across the United States. The proportions of seizure-free patients in each group were 72% (surgical) and 23% (non-surgical). Students t-test was used to statistically analyze the group means of age, age of onset, duration of epilepsy, and the number of AEDs. [8], Hippocampal sclerosis is often associated with temporal lobe epilepsy. Paying attention to these non-seizure symptoms of epilepsy associated with MTS is crucial. Before the surgery, participants will have the following procedures to provide information on the correct surgical approach. Previous studies assessing the prognosis for seizure control by medication in patients with TLE-HS are limited to relatively short-term follow-ups of 12 years [2,8,10]. Depression and Anxiety in the Epilepsies: from Bench to Bedside. Disclaimer. The glutamate imbalance may lead to a complex metabolic process that is damaging to nerve cells. [Temporal mesial sclerosis syndrome in epilepsy]. 2014 Jun;23(6):448-53. doi: 10.1016/j.seizure.2014.03.003. The exact cause of mesial temporal sclerosis is still unclear. Temporal Lobe Epilepsy in the Elderly The first line treatment areantiseizure medications. Pharmacoresistance with newer anti-epileptic drugs in mesial temporal lobe epilepsy with hippocampal sclerosis. In some cases, the cause of the condition is unknown. Epilepsia. Wiebe et al. An official website of the United States government. Mesial Temporal Sclerosis The temporal lobe is a part of the brain under the temples on the side of the head. Modulatory Potential of LncRNA Zfas1 for Inflammation and Neuronal Apoptosis in Temporal Lobe Epilepsy. We investigated seizure frequency in the last 2 years and divided the patients into two groups. Corrections, Expressions of Concern, and Retractions. Before The average age of patients in Group 1 was higher than that of Group 2 (p = 0.0468). The study is designed to evaluate the safety and efficacy of the Visualase MRI-guided laser ablation system for mesial temporal epilepsy (MTLE). The United Brain Association No Mind Left Behind. In Group 1, 58.3% of the patients were working, while 79.3% of the patients in Group 2 could not hold a job. Thus, the social adjustment of the patients is a matter that demands careful consideration. Focal seizure symptoms may include: A doctor may suspect MTS if a patient presents symptoms of temporal lobe epilepsy and has experienced any of the conditions known to be associated with MTS. The purpose of the study is to evaluate the safety and efficacy of the Visualase MRI-guided laser ablation system for necrotization or coagulation of epileptogenic foci in patients with intractable mesial temporal lobe epilepsy. 2008 Aug;49(8):1324-32. doi: 10.1111/j.1528-1167.2008.01714.x. Castro LH, Serpa MH, Valrio RM, Jorge CL, Ono CR, Arantes PR, Rosemberg S, Wen HT. He C, Su C, Zhang W, Zhou Q, Shen X, Yang J, Shi N. Yonsei Med J. and transmitted securely. On the other hand, it is an often unrecognized cause of cognitive decline, typically presenting with severe memory loss. A focal seizure may spread to become a generalized seizure, which involves the entire brain and may cause a sudden loss of awareness or consciousness. eCollection 2022. An official website of the United States government. This device involves wires that are placed into a region of the brain called the thalamus, which is a deep nucleus in the brain that works as a hub that connects different brain regions. The surgery has a high success rate for eliminating seizures, and patients usually dont experience any new neurological symptoms. [4] Mesial temporal sclerosis used to be most commonly found as a single lesion in the brains of chronic epileptics who died a natural death which was estimated to be developed as a result of continued febrile convulsions. This means that pyramidal neuronal cells are lost, granule cells are spread widely or driven off, and glial cells are changed in response to damage to the central nervous system (CNS). These can present as. Group 2 included a significantly higher rate of patients who had more than one seizure per week at the onset (p = 0.0328), as well as a greater mean number of anti-epileptic drugs taken (p = 0.0024). Purpose: Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most frequent pharmaco-resistant epilepsy. "Rather than removing tissue so it will not cause seizures, we can heat the tissue, simply by inserting a laser catheter. Some neuroimaging literature demonstrated morphometric changes in white matter, including the bilateral frontal lobes, bilateral temporal lobes, corpus callosum, and bilateral cerebellar hemispheres, in TLE-HS [15, 16]. Many people with MTS also suffer from other brain-related issues, a condition called co-morbidity. a negative predisposition toward brain surgery). 8600 Rockville Pike There is no evidence that any one medication is most effective. In patients who underwent surgery for refractory TLE, 56.9% were employed, and 75.2% had been seizure-free for a period of at least 1 year before the last follow up [12]. The number of patients who became seizure free was in total 37 (45%); in the surgical group 26 and in the non-surgical group 11. Epub 2018 Oct 20. What If I Have a Seizure While I Exercise? Patients suspected to have other abnormal findings such as focal cortical dysplasia, tumor, or cerebral infarction were excluded. Figure 23.4. Clinical factors such as sex, age, age of onset, durations of epilepsy, side of HS in MRI, presence of febrile seizures, GTCs, and the numbers of anti-epileptic drugs (AEDs) taken before were extracted from the medical records. 2 Mesial temporal sclerosis (MTS) is the most common pathologic entity encountered in epilepsy surgery series. We determined that additional extrahippocampal temporal abnormalities were present in 76 patients who had right or left MTS. Six patients in Group 2 (20.7%) were on public assistance, while no patients of Group 1 were on. We hypothesize two reasons for this difference. Hippocampal sclerosis ( HS) or mesial temporal sclerosis ( MTS) is a neuropathological condition with severe neuronal cell loss and gliosis in the hippocampus, specifically in the CA-1 (Cornu Ammonis area 1) and subiculum of the hippocampus. Positron emission tomography is also used as an aid for diagnosis. What is the temporal lobe made of? It is most commonly diagnosed at or after adolescence. In some cases, the cause of MTS remains unknown. There is no evident information addressing the alteration of brain structure and seizure frequency in aging patients with chronic TLE-HS. J Mol Neurosci. Almost half of the patients with epilepsy undergoing treatment at a general hospital were reported to have a job [23]. The tool doctors most commonly use to diagnose MTS is a magnetic resonance imaging (MRI) scan. [20] The CA2 region is typically spared, and the subiculum may be involved. Many of the explanations for the increased incidence of these conditions in people with lower socioeconomic status (SES) suggest they are the result of poor diet, low levels of exercise, dangerous jobs (exposure to toxins etc.) Losing neurons: selective vulnerability and mesial temporal sclerosis. Thus, in cases where an appropriate second AED has failed, the option of surgical treatment should be presented to patients as that with the best potential outcome. FOIA Clinical factors such as age, gender, lesion side, previous medical history, duration of illness, seizure frequency and IQ did not correlate to prognosis. The https:// ensures that you are connecting to the 3 For example, the risk of mesial temporal sclerosis developing from childhood complex febrile seizures is 3%. Rasia-Filho AA, Guerra KTK, Vsquez CE, Dall'Oglio A, Reberger R, Jung CR, Calcagnotto ME. The surgical treatment for mesial temporal sclerosis is called temporal lobectomy. Epilepsia. The mean follow-up period in our hospital was 27.313.0 years. 2022 Aug;7 Suppl 1(Suppl 1):S94-S120. Disclaimer. Data Availability: All relevant data are within the paper and its Supporting Information files. One study demonstrated that 38.6% of sporadic benign temporal lobe epilepsy cases had MRI evidence of unilateral HS [18]. Surgical intervention can result in complete seizure remission rates of up to 80% in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Careers. Clipboard, Search History, and several other advanced features are temporarily unavailable. In the mid-20th century, the term "psychomotor epilepsy" was introduced by Gibbs and Gibbs to describe the characteristic . MTS affects the hippocampus which is the brain region that is involved in memory formation and retrieval, and the amygdala which is involved in emotional processing. Front Synaptic Neurosci. Department of Psychiatry and Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Regarding social adjustment, Group 2 contained significantly fewer current jobholders than Group 1 (p = 0.0288). Please donate generously today; help make a difference for your loved ones, now and in their future. The reason given for the selection of non-surgical treatment was also documented. Glutamate is a chemical vital to communication between brain cells, but studies have found that an event such as a brain injury can cause an imbalance of the chemical in the brain. after the initial condition that causes scarring of the temporal lobe. Here are a few of the disorders, As many as a third of people with MTS experience mood disorders such as, People with MTS are at increased risk for epilepsy-related psychiatric conditions such as, Researchers are working to understand the causes of MTS and the biochemical processes that may make the condition worse. Bethesda, MD 20894, Web Policies [19][20] There are three specific patterns of cell loss. Youji Takeda, and transmitted securely. Shown is a T2 weighted coronal MRI taken from a 54-year-old woman with a history of mesial temporal sclerosis on the left (arrow) with significant loss in hippocampal volume and abnormal increased T2 signal.MRI, magnetic resonance imaging; MTLE, mesial temporal lobe epilepsy. Mesial temporal sclerosis (MTS) is a condition characterized by scarring and deterioration of the inner part of the brains temporal lobe. and transmitted securely. 1 Its histologic confirmation is a . Epidemiological studies have revealed that epilepsy is most common among elderly persons [14], but the impact of aging on the course of epilepsy is unknown.
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