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. Snyder1 1department of comparative pathobiology, purdue university, west lafayette, indiana, usa. 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. Hippocampal sclerosis, also known as ammon horn sclerosis, is a common pathologic finding in surgical specimens from patients with tle. Fifteen patients 35% had a history of prolonged febrile convulsions pfc in early childhood. 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 is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated. The ilae classification of hs in patients with tle. Bilateral mesial temporal sclerosis radiology case.
A new clinicopathological classiwcation system for 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. 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. May 14, 2014 hippocampal sclerosis hs is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy mtle. Pathogenesis, induced rodent models and lesions alok k. Hippocampal sclerosis and atrophy were found in nine 25. Top meningioma treatment neurological surgery long. Mesial temporal sclerosis mts is a common pathologic finding in patients with. Histological classification of mesial temporal sclerosis. 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. The purpose of this study was to estimate the prevalence of mts by mri in the general population. In vivo diffusion tensor imaging and histopathology of the. 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.
Yet, temporal lobe epilepsy is not a homogeneous cerebral disorder. Clinical manifestations preexisting complex febrile convulsions are common. Mts, hippocampal sclerosis hs, ammon horn sclerosis. It is seen in up to 65% of autopsy studies, although significantly less on imaging. 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. Temporal profile of clinical signs and histopathologic. The term hippocampal sclerosis was originally used to describe a shrunken and hardened hippocampus, which histologically displayed neuronal loss and glial proliferation.
Tle is the most common form of epilepsy with focal seizures. The term ammons horn sclerosis first coined by sommer in 1880 is often used synonymous with hs. The most commonly found injury in adults is mesial temporal sclerosis mts 2,3. Manchester triage system mesial temporal sclerosis modified trichrome stain mouse thyroid stimulator muir torre syndrome sclerosis sklerosis gr. Mri evidence of mesial temporal sclerosis in subjects. Mesial temporal sclerosis mesial temporal sclerosis, also known as hippocampal sclerosis, is the most common cause. Search for a doctor by neurological surgery at columbia. 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. Loss of digitations of the hippocampal head on highresolution fast spinecho mr. Madisons epilepsy cure meet the doctor video series complete.
A peak correlation was observed in the ipsilateral perirhinal cortex. 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. International consensus classification of hippocampal sclerosis in. Mri scan commonly displays increased t2 signal and hippocampal atrophy. Mesial temporal sclerosis definition of mesial temporal.
Pathogenetic mechanisms underlying this distinct hippocampal pathology remains undetermined. I dont go back to see him until may 5 to get a better explanation. The 20 international league against epilepsy ilae classification segregates hs into typical type 1 and atypical type 2 and 3 groups, based on the. Lesional mesial temporal lobe epilepsy and limited. Mesial temporal lobe epilepsy an overview of surgical. Mesial temporal sclerosis mts is the most recognized finding in drug resistant, chronic temporal lobe epilepsies. Many of these changes are evident at magnetic resonance imaging.
Fast fluidattenuated inversion recovery flair compared with t2weighted spinecho in the magnetic resonance diagnosis of mesial temporal sclerosis investigative radiology, vol. A condition characterised by induration of the middle temporal lobe, associated with cortical dysplasia and intractable temporal lobe epilepsy. Detection of hippocampal pathology in intractable partial epilepsy. 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. 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. Hippocampal sclerosis mesial temporal sclerosis mts needs consideraton with clinical and eeg correlation. Objective amygdala enlargement ae has been suggested to be a subtype of mesial temporal lobe epilepsy mtle. Improved detection of subtle mesial temporal sclerosis. A sign of mesial temporal sclerosis article pdf available in american journal of neuroradiology 193. A new clinicopathological classification system for mesial temporal. Auditory aura s usually manifest as auditory hallucination such as sounds.
Pdf childhood mesial temporal sclerosis researchgate. 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. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. Amygdalohippocampectomy is a wellestablished, standard surgery for medically intractable mesial temporal lobe epilepsy mtle. 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. Associated hippocampal atrophy and gliosis is common. A seizure associated neuronal loss and gliosis in hippocampus. Patients often complain of poor memory for recent events, and this may get worse as the epilepsy continues. Temporal lobe epilepsy with mesial temporal sclerosis.
Neuropathological features of mesial temporal sclerosis. Early childhood prolonged febrile convulsions, atrophy and. Epilepsy is a cns disorder affecting about 70 million people worldwide. The complete disconnection of the epileptogenic neural networks in the mesial temporal lobe determines the success of resective surgery. Hippocampal sclerosis hs is considered the most frequent neuropathological finding in patients with mesial temporal lobe epilepsy mtle. Temporal lobe epilepsy tle patients with mesial temporal sclerosis mts have abnormal dti parameters of the fimbriafornix relative to tle patients without mts. Temporal lobe sclerosis associated with hippocampal. 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. Mesial temporal sclerosis and epilepsy health science journals. 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. Magnetic resonance imaging detection of mesial temporal. Fiftyeight specimens showed features of ammons horn sclerosis. Hippocampal sclerosis is a very common feature of temporal lobe epilepsy complex partial seizures or limbic epilepsy.
Little is known about the epidemiology of tle, because it requires advanced neuroimaging, positive eeg, and appropriate clinical semiology to confirm the. Anterior temporal lobectomy for older adults with mesial. Hippocampal sclerosis, temporal lobe sclerosis, and amygdaloid sclerosis. Mesial temporal sclerosis mts is the most recognized finding in drug. 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. Mesial temporal sclerosis mts is the most recognized wnding in drug resistant, chronic temporal lobe epilepsies 5. The present study was performed to clarify the surgical outcomes and pathology of ae. Surgery for amygdala enlargement with mesial temporal lobe. I started seeing a new neurologist who immediately said he was going to find out the cause, or do is best to. Aetiology major cerebral trauma, infection, febrile illness in childhood. Mesial temporal hippocampal sclerosis mesial temporal sclerosis syn. Mesial temporal sclerosis is a specific pattern of hippocampal neuron cell loss. 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. Temporal profile of clinical signs and histopathologic changes in an f344 rat model of kainic acidinduced mesial temporal lobe epilepsy alok k.
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. 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. Surgical treatment of drugresistant epilepsy due to. Limbic system abnormalities associated with mesial. 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. A grading system for mesial temporal pathology hippocampal. As mtle is often drug resistant, the treatment of choice is surgery of the epileptogenic focus. Of 738 patients operated for tle, 78 patients underwent limited resections for lesional mtle 19902000. Introduction partial seizures of temporal lobe origin are common in both children and adults. Recent findings suggest a developmental malformation of. Effects of chronic temporal lobe epilepsy on memory functions.
Social perception in mesial temporal lobe epilepsy. The etiology of mesial temporal sclerosis remains hotly debated. Neurological and mental state usually normal prior to seizure onset. Mesial temporal lobe epilepsy mtle is the most common form of epilepsy in adults. Mesial temporal sclerosis mts is the most common histopathology occurring in patients with drugresistant temporal lobe epilepsy. However, in the case of mtle without hippocampal atrophy or sclerosis, amygdalohippocampectomy is associated with. 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.
Pdf mesial temporal sclerosis and epilepsya case report. S nyder1 1department of comparative pathobiology, purdue university, west lafayette, in 47907, usa. Identification of mesial temporal sclerosis is critical in the evaluation of individuals with temporal lobe epilepsy. 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 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. The term mesial temporal sclerosis as an alternative to hs was introduced in recognition of the. Hippocampal sclerosis hs is a common pathology encountered in mesial temporal lobe epilepsy mtle as well as other epilepsy syndromes. Cell loss might involve sectors ca1 and ca4, ca4 alone, or ca1 to ca4. International consensus classification of hippocampal. 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. Mesial temporal sclerosis mts is the most common pathological finding in temporal lobe epilepsy tle, but the relationship between mts.
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. Epileptic seizures of the temporal lobe constitute the most frequent presentation of drugresistant epilepsy which satisfactorily responds to surgical treatment 1. Epilepsies associated with hippocampal sclerosis springerlink. Mesial temporal lobe sclerosis mts is the most common pathology associated with intractable temporal lobe epilepsy.
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 is the most common cause of medically refractory temporal lobe epilepsy tle. Top meningioma treatment neurological surgery nspc. Hippocampal sclerosis hs is the most frequent histopathology. Mri evidence of mesial temporal sclerosis in subjects without. The miracle on fort washington avenue aneurysm surgery is a personal choice, says dr.
The neuropathological features of temporal lobe epilepsy were studied utilising 100 consecutive surgical specimens from patients with medically refractory complex partial seizures. Mesial temporal sclerosis hard seahorses and shrunken. Little is known about the epidemiology of tle, because it requires advanced neuroimaging, positive eeg, and appropriate clinical semiology to confirm the diagnosis. However, most reports related to ae have referred to imaging studies, and there have been few reports regarding surgical and pathological findings. Amnesia is the rule for the blank spell and the automatism. Over the past decades, there have been various attempts to classify the variants of hippocampal neuronal cell loss in relation to postoperative outcome. Simple focal seizures are the initial nonfebrile seizures followed by. In vivo mapping of hippocampal subfields in mesial temporal. 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. The pathology most commonly present in cases of idiopathic temporal lobe epilepsy is most obvious. Although often used interchangeably with hs, the term mesial temporal sclerosis mts is more appropriate for cases in which. The prevalence of mesial temporal sclerosis among all children having magnetic resonance imaging brain studies performed for seizures was much higher, being 12. Although seizures may arise from any area of the temporal lobe, in the majority of patients seizures arise in mesial structures i.
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. Pdf loss of digitations of the hippocampal head on high. 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. A new clinicopathological classification system for. Mesial temporal sclerosis radiology reference article.
Pdf neuropathology of temporal lobe epilepsy researchgate. A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. 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. Mesial temporal sclerosis mesial temporal sclerosis, also known as hippocampal sclerosis, is the most common cause of temporal lobe epilepsy found at surgery. The 20 international league against epilepsy ilae classi. 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. 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. Clinical examination revealed no neurological deficit. Secondary generalisation is much less common than in extratemporal lobe epilepsy. Robert solomon im living a normal life for the first time. A new clinicopathological classification system for mesial.
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