It Goes Downhill from Here but Do Not Despair: Mesial Temporal Lobe Epilepsy is a Progressive Disease, but it Can be Benign

Jobst, Barbara C.

doi:10.5698/1535-7511-16.6.380

Cited by 2 publications

(2 citation statements)

References 12 publications

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“…Furthermore, we recognize that there are several independent determinants of postsurgical outcome other than extent of resection that are not considered in this review, but that may act as important effect modifiers. A major randomized controlled trial (ERSET) has shown that best seizure outcomes are associated with early surgical intervention, and there is an increasingly well‐held belief that mTLE is a progressive disease . Very few studies reviewed here explicitly discussed (or controlled for) the age of disease onset in their cohorts, so we are unable to comment on the putative effect modification of this factor on extent of resection.…”

Section: Discussionmentioning

confidence: 91%

Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy

et al. 2019

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Surgical management of medically intractable epilepsy was historically based on the premise of excising the presumed substrate of disease, that is, “the epileptogenic zone.” There was early interest in establishing the extent of resection of the temporal lobe that optimized postoperative reduction in seizure burden while preserving neurocognitive function. Studies approaching this question used varied methods of defining and measuring “extent,” complicating the task of distilling evidence‐based recommendations for surgical practice. A palpable shift in the paradigm of surgical epilepsy has gained traction and greatly altered not only the kind of studies being undertaken but the focus of inquiry itself. Key to this paradigm shift has been the increasingly well‐held notion that epilepsy, far from being a disease of a single problem focus, is rather a disease of a problem network. Where a former generation of investigators labored to find an optimal extent of resection, concentrating on magnetic resonance imaging–visible lesions and on standardization of the extent of resection (ie, “standard temporal lobectomy”), the modern strategy is more concerned with understanding network activation and its concordance with presurgical clinical and electrophysiological features and the organization of epileptic activity over time. The vital lessons of the early literature investigating optimal extent of resection, however, remain informative to the field, and it is worthwhile to contextualize them within the modern network‐focused paradigm. In this comprehensive review of the literature, we aim to recapitulate the major findings of the “optimal extent of resection” literature (focusing on both seizure control and neuropsychological outcomes) and distill wherever possible the consensus findings that may guide surgical approach to epileptic disease of the temporal lobe. We also review the particular implications of modern laser ablation techniques on the question of “optimal extent of resection” in temporal lobe epilepsy, and contextualize them as a marker of a shifting paradigm.

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Section: Discussionmentioning

confidence: 91%

Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy

et al. 2019

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“…The prognosis of FTLE with a high incidence of febrile seizures was almost good. However, in some patients with genetically based MTLE-HS and histories of febrile seizures, the prognosis was poor, and the underlying pathogenic genes remain unknown[ 57 ]. A growing number of studies had proven that HS and MTLE had polygenic or multifactorial modes of inheritance.…”

Section: Discussionmentioning

confidence: 99%

Molecular typing of familial temporal lobe epilepsy

Liu¹,

Qiao²,

Wei³

et al. 2022

WJP

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The pathogenesis of temporal lobe epilepsy (TLE) was originally considered to be acquired. However, some reports showed that TLE was clustered in some families, indicating a genetic etiology. With the popularity of genetic testing technology, eleven different types of familial TLE (FTLE), including ETL1-ETL11, have been reported, of which ETL9-ETL11 had not yet been included in the OMIM database. These types of FTLE were caused by different genes/Loci and had distinct characteristics. ETL1, ETL7 and ETL10 were characterized by auditory, visual and aphasia seizures, leading to the diagnosis of familial lateral TLE. ETL2, ETL3 and ETL6 showed prominent autonomic symptom and automatism with or without hippocampal abnormalities, indicating a mesial temporal origin. Febrile seizures were common in FTLEs such as ETL2, ETL5, ETL6 and ETL11. ETL4 was diagnosed as occipitotemporal lobe epilepsy with a high incidence of migraine and visual aura. Considering the diversity and complexity of the symptoms of TLE, neurologists enquiring about the family history of epilepsy should ask whether the relatives of the proband had experienced unnoticeable seizures and whether there is a family history of other neurological diseases carefully. Most FTLE patients had a good prognosis with or without anti-seizure medication treatment, with the exception of patients with heterozygous mutations of the CPA6 gene. The pathogenic mechanism was diverse among these genes and spans disturbances of neuron development, differentiation and synaptic signaling. In this article, we describe the research progress on eleven different types of FTLE. The precise molecular typing of FTLE would facilitate the diagnosis and treatment of FTLE and genetic counseling for this disorder.

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It Goes Downhill from Here but Do Not Despair: Mesial Temporal Lobe Epilepsy is a Progressive Disease, but it Can be Benign

Cited by 2 publications

References 12 publications

Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy

Tracking a changing paradigm and the modern face of epilepsy surgery: A comprehensive and critical review on the hunt for the optimal extent of resection in mesial temporal lobe epilepsy

Molecular typing of familial temporal lobe epilepsy

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