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Updated: Sep 26, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
[Prognostic factor for medical control for seizures in patients with radiologic evidence for mesial temporal lobe
M Falip1, M Gratacós, E Santamarina
1Servicio de Neurología, Unidad de Wpilepsias, Hospital General Universitario Vall d'Hebron, Barcelona, España. marceana@teleline.es
Introduction:
Patients with mesial temporal lobe sclerosis (MTS) usually have suffered a brain insult during early childhood, a febrile convulsion in most cases. Complex partial seizures start after a seizure free period of variable duration. These complex partial seizures have an stereotypic semiology. Often, these seizure are not controlled with medical therapy, previous studies shows a rate of control not superior of 30%. AIM. To know the prognosis for medical control of patients with MTS and to find related factors.
Patients And Methods:
The clinical characteristics of 51 patients with temporal lobe epilepsy and radiologic evidence of MTS (hippocampus atrophy or increased signal on T2 or Flair magnetic resonance sequences).
Results:
51 patients, of them 17 (34%) were men. 17 (34%) presented right MTS, 30 (60%) left MTS and 2 (4.3%) bilateral MTS. 16 patients (34.8%) referred autonomic aura, 14 (27.5%) psychic aura, 4 (7.8%) dysphasia and 13 (25.5%) no aura, in 2 (3.9%) aura were mixed: autonomic psychic. The aura was associated to the lesion laterality (p= 0.023) and to the reference of some antecedent of cerebral aggression during early childhood (p= 0.011). Concerning to the seizure control, 15 patients (29.2%) were seizure free in the last 6 month and 36 (70.6%) remaining uncontrolled. The associated factors to the medical control were the age of onset (p= 0.024) and the duration of the epilepsy (p= 0.018).
Conclusions:
Around 29% of patients with MTS can be controlled with medical therapy. Seizure control is related with later age of onset and short duration of the epilepsy
Insights
Mesial temporal lobe sclerosis (MTS) affects seizure control, with only 29% of patients achieving medical control. Later age of onset and shorter epilepsy duration are linked to better seizure outcomes in MTS patients.
Area of Science:
- Neurology
- Epileptology
- Neuroimaging
Background:
- Mesial temporal lobe sclerosis (MTS) is often preceded by early childhood brain insults, typically febrile convulsions.
- Complex partial seizures in MTS patients exhibit characteristic semiology and often resist medical management.
- Previous studies indicate a medical control rate not exceeding 30% for MTS-related seizures.
Purpose of the Study:
- To determine the prognosis for medical control in patients diagnosed with Mesial Temporal Lobe Sclerosis (MTS).
- To identify factors associated with seizure control in individuals with MTS.
Main Methods:
- A cohort of 51 patients with temporal lobe epilepsy and radiologic evidence of MTS was analyzed.
- Clinical characteristics, including seizure semiology and MRI findings (hippocampal atrophy or signal changes), were recorded.
- Statistical analysis was performed to identify associations between patient characteristics and seizure control.
Main Results:
- Of the 51 patients, 34% were male, and 60% had left-sided MTS.
- Aura characteristics varied, with autonomic aura reported in 34.8% and psychic aura in 27.5%. Aura laterality correlated with lesion side (p=0.023) and childhood brain insult history (p=0.011).
- Only 29.2% of patients achieved seizure freedom in the last six months, while 70.6% remained uncontrolled. Later age of onset (p=0.024) and shorter epilepsy duration (p=0.018) were associated with better medical control.
Conclusions:
- Approximately 29% of patients with Mesial Temporal Lobe Sclerosis (MTS) can achieve seizure control through medical therapy.
- Factors positively influencing seizure control in MTS include a later age of epilepsy onset and a shorter duration of the condition.
