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Mesial temporal sclerosis: pathogenesis, diagnosis, and management
1Department of Neurology and Neurosurgery, University of Minnesota Medical School, Minneapolis.
Abstract:
Mesial temporal sclerosis (MTS) is probably the most common symptomatic pathologic entity--alone or mixed with other pathologic features--for seizures of temporal lobe origin. The pathophysiology of MTS, including any genetic influence, needs clarification. A characteristic ictal expression for seizures of MTS origin appears not to exist. The majority of patients (78%) with postresection MTS who are seizure-free have tightly localized interictal abnormalities restricted to F7/F8, Sp1/Sp2, T3/T4, and T5/T6 more than 96% of the time. MRI abnormalities may be seen in 55% of patients with MTS if both "hard" and "soft" criteria are used or in 20% when only "hard" criteria are used. The neuropsychologic evaluation of patients with MTS, which includes intracarotid amobarbital test (IAT), may prove to be increasingly useful in identifying patterns of cognitive deficit that correlate with enhancement of both lateralizing and localizing preoperative information.
Insights
Mesial temporal sclerosis (MTS) is a common cause of temporal lobe seizures. Further research is needed to clarify its pathophysiology and genetic factors.
Area of Science:
- Neurology
- Pathology
- Epileptology
Background:
- Mesial temporal sclerosis (MTS) is a frequent cause of temporal lobe epilepsy.
- The underlying pathophysiology and genetic contributions to MTS require further elucidation.
- Distinctive ictal patterns for MTS-originating seizures are not well-defined.
Purpose of the Study:
- To summarize current understanding of Mesial Temporal Sclerosis (MTS).
- To highlight the diagnostic utility of neuroimaging and neuropsychological testing in MTS.
- To underscore the need for further research into MTS pathophysiology.
Main Methods:
- Review of existing literature on Mesial Temporal Sclerosis.
- Analysis of electroencephalography (EEG) and magnetic resonance imaging (MRI) findings in MTS patients.
- Evaluation of the role of the intracarotid amobarbital test (IAT) in neuropsychological assessment.
Main Results:
- Seventy-eight percent of seizure-free patients post-resection show localized interictal abnormalities.
- MRI detects abnormalities in 55% of MTS patients using broad criteria, versus 20% with strict criteria.
- Neuropsychological evaluations, including IAT, can aid in lateralizing and localizing preoperative information.
Conclusions:
- MTS is a significant cause of temporal lobe seizures.
- EEG and MRI play crucial roles in identifying MTS.
- Neuropsychological testing, particularly IAT, offers valuable preoperative insights for MTS patients.
