Summary: Purpo.re: To learn the prevalcnce of epilepsy in Silivri, a western town of Turkey, a randomized door-to-door wvey was conducted u\ing a standard questionnaire. The method of the study was adopted from the suggestions of the World Health Organization (WHO) for prevalence studies in developing countries, and the criteria were derived from ures at the onset or during the course of the disease, a figure that reveals the high prevalence of mystical beliefs about the disease in the study area.

SUMMARYSeizure outcome in mesial temporal lobe epilepsy related to hippocampal sclerosis (MTLE-HS) that was evaluated according to a noninvasive protocol was assessed in 165 patients and reported using both Engel's and ILAE classifications. The mean postoperative follow-up was 5.0 ± 2.7 years. At the end of first year, 77.1% of patients were in Engel-I, and 52.7% were in ILAE-I. Antiepileptic drugs (AEDs) were discontinued in 41 patients (42.7%), all remained seizure-free for >2 years that could be accepted as "cure." Thirty-six patients had recurrences, 19 had running-down phenomena. Anterior temporal lobectomy (ATL) was performed in 27 patients with a better outcome when compared to patients operated by selective anterior hippocampectomy. Clinical risk factors for better and worse outcome, which show some similarity in different reports, seem to veil the main reason, which is the accurate delineation of epileptogenic zone considering the presence of different subgroups and underlying developmental pathologies. KEY WORDS: Hippocampal sclerosis, Temporal lobe epilepsy, Surgery.Mesial temporal lobe epilepsy (MTLE) is a form of focal seizure disorder that is refractory to antiepileptic drug (AED) therapy and known to be remediable by surgery, and hippocampal sclerosis (HS) is the most frequent substrate obtained from the surgical specimens in these patients. About 55-70% of patients undergoing temporal resection become completely seizure-free (Engel et al., 1993), where 20-30% of patients still experience seizures following surgery (Wyler et al., 1995;. Moreover, it is difficult to obtain the information solely on patients with MTLE-HS in the literature due to the format of published reports usually providing data on various etiologies, missing number of patients cured or with either recurrence or running-down phenomena.In this study, we present a large surgical cohort data, examining the year-by-year seizure outcome, during a longterm postsurgical follow-up in patients with MTLE-HS evaluated nonivasively according to a standard protocol METHODSOut of 183 patients with MTLE-HS who underwent surgery since 1995, 165 patients who were followed for at least 1 year were included. Patients with normal MRI or with structural lesions other than HS were excluded. Two patients were reoperated due to insufficient seizure control and excluded at the time of second surgery. All patients were evaluated according to a noninvasive protocol including clinical assessment, ictal video-EEG, MRI, neuropsychological, and psychiatric investigations. The intracarotid amobarbital procedure was performed in 65 patients with bilateral memory deficits, left-sided focus, or discordant findings. Patients were followed for 6 months after surgery and then yearly when possible. Seizure outcome was classified according to the Engel's (Engel et al., 1993) and ILAE classifications (Wieser et al., 2001). AEDs were discontinued in patients who remained seizure-free for at least 2 years. 696

To evaluate the hypothetical link between apolipoprotein E (APOE) polymorphisms and mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and whether presence of APOE epsilon4 allele shortens the latent period between febrile seizures and epilepsy. A further interest is whether presence of APOE epsilon4 allele has an impact on severity of the disease. Forty-seven patients with MTLE-HS were compared with 62 controls. APOE polymorphisms were determined from lymphocytes by standard methods. Eight patients (17%) and 10 controls (16.1%) were demonstrated to have one APOE epsilon4 allele. There was not any statistically significant difference in APOE epsilon4 frequency between patients and controls (P > 0.05). There was not any difference statistically according to onset age of epilepsy and the presence of APOE epsilon4 allele within patient group. APOE epsilon4 polymorphisms did not influence the severity of epilepsy. APOE epsilon4 polymorphisms had no impact on outcome after surgery. Patients with bilateral memory deficits, bilateral hippocampal atrophy and with bilateral epileptiform interictal EEG transients, were independently compared with patients having unilateral features and there were not any statistically significant differences. This study has found no association between APOE epsilon4 polymorphisms and presentation of MTLE-HS in a group of Turkish patients.

We have shown that there is a considerable risk of having visual field deficits after standard transsylvian selective amygdalohippocampectomy owing to the interruption of the anterior bundle of the optic radiation fibers, which most likely occurs while opening the temporal horn through the inferior limiting sulcus of the insula.

Summary:Purpose: Mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS) is the most common of the antiepileptic drug (AED)-resistant seizure syndromes that are remediable mostly with surgery, although a small group of patients have benign prognosis with fewer seizures. Materialspecific memory impairment is an important feature in these patients and may be related to both the structural abnormality and the frequent seizures. In this study, we investigated the relation between memory deficit and HS by taking seizure frequency into account.Methods: The patients were evaluated according to a standard protocol and divided into two groups, considering their response to AEDs: the good-responder group (GRg, n = 18) and the pharmacoresistant group (PRg, n = 95). They were administered a neuropsychological test battery that included verbal and nonverbal memory tests, compared with each other and with a normal control group (n = 29). The responder group was evaluated by the same battery once again (mean, 23 months; SD, 8.25; range,.Results: Both GR and PR patient groups had poorer memory than the normal controls in all memory tests (p < 0.05). However, the comparison of GRg with PRg revealed that only the digit-span test was significantly worse in PRg (p = 0.0061), and no difference was found in any other memory scores. The reevaluation of the GRg showed no significant difference between the first and second evaluation.Conclusions: We concluded that the memory impairment in patients with MTLE-HS was permanent and might be related to the direct effect of HS itself. Therefore patients with good response to AEDs can be used as a model for investigating the memory problems in patients with MTLE-HS.