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Progressive hippocampal atrophy in chronic intractable temporal lobe epilepsy
T J O'Brien1, E L So, F B Meyer
1Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Annals of Neurology
|April 22, 1999
Summary
Uncontrolled temporal lobe epilepsy can cause progressive hippocampal atrophy. Surgical removal of the affected hippocampus and amygdala successfully eliminated seizures in one patient.
Area of Science:
- Neurology
- Neurosurgery
- Neuroimaging
Background:
- Complex partial seizures and secondary generalized seizures can be intractable.
- Temporal lobe epilepsy (TLE) is a common cause of drug-resistant epilepsy.
- Hippocampal atrophy is a known feature in some epilepsy cases.
Observation:
- A 28-year-old male patient presented with long-standing, intractable complex partial and secondary generalized seizures.
- Serial magnetic resonance imaging (MRI) scans over 4 years revealed a progressive decrease in left hippocampal volume.
- The patient had no history of status epilepticus.
Findings:
- Left anterior temporal lobectomy combined with amygdalohippocampectomy resulted in complete seizure freedom.
- The patient remained seizure-free at a 12-month follow-up.
- Progressive hippocampal atrophy can occur in patients with uncontrolled TLE, independent of status epilepticus.
Implications:
- This case suggests that ongoing seizures in TLE may drive hippocampal volume loss.
- Surgical intervention can be effective in achieving seizure control and potentially halting atrophy.
- Further research is warranted to understand the mechanisms of seizure-induced neurodegeneration in TLE.