Unilateral mesial temporal atrophy after a systemic insult as a possible etiology of refractory temporal lobe epilepsy: case report

Abstract

Mesial temporal sclerosis is the main pathological substrate present in refractory temporal lobe epilepsy and its presence is often related to the occurrence of febrile seizures in infancy. There is an on-going discussion on the nature of mesial temporal sclerosis as it related to epilepsy: cause or consequence. A previously normal child developed hyperosmolar coma after abdominal surgery at the age of 6. Three months afterwards he developed simple and complex partial seizures with an increasing frequency and refractory to multiple mono- and polytherapic drug regimens. He was evaluated for surgery at the age of 13. Ictal and interictal recordings showed left temporal lobe abnormalities. Early CT scanning suggested left temporal atrophy. MRI showed mesial temporal sclerosis. Neuropsychological testing showed verbal memory deficits and he passed a left carotid artery amytal injection. He was submitted to a cortico-amygdalo-hippocampectomy and has been seizure-free since then. The clinical data obtained from this patient suggest that at least in this case mesial temporal sclerosis would be related to the cause of epilepsy and not resultant from repeated seizure activity.

Mesial temporal sclerosis in children

“…There was no silent interval in 39% of the children who started symptomatology with temporal focal seizures and in other 22% the interval was less than one year, which may suggest that in many patients MTS could be the factor responsible for the fi rst seizures and not their consequence as has been pointed out in the past 2,15 .…”

Mesial temporal sclerosis – a late complication in four allogeneic pediatric recipients with persistent seizures after an acute episode of cyclosporine-A neurotoxicity

“…4 Only brain MRI using T2-weighted or FLAIR and other optimized sequences allows for appropriate diagnosis of MTS by showing an increased signal of the hippocampus and an enlargement of the ipsilateral temporal horn, with or without associated temporal neocortical atrophy. 4,9 CT scan usually only allows recognition of nonspecific signs of temporal atrophy. 10 MTS has never been described after transplant except in the context of human herpesvirus 6 encephalitis.…”