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Updated: Mar 15, 2026
Anteromesial Temporal Lobectomy for Medically Intractable Temporal Lobe Epilepsy: An Operative Study
Published on: August 15, 2025
Clinical and electrophysiological findings in mesial temporal lobe epilepsy with hippocampal sclerosis, based on the
F Irsel Tezer1, Farid Xasiyev1, Figen Soylemezoglu2
1Hacettepe University, Faculty of Medicine, Dept. of Neurology, Ankara, Turkey.
Insights
Hippocampal sclerosis (HS) types 2 and 3 in mesial temporal lobe epilepsy (MTLE) are linked to a higher incidence of generalized tonic-clonic seizures and a family history of epilepsy. These findings aid in understanding HS epileptogenicity and prognosis.
Area of Science:
- Neurology
- Epileptology
- Pathology
Background:
- Hippocampal sclerosis (HS) is a common pathology in mesial temporal lobe epilepsy (MTLE).
- The 2013 International League Against Epilepsy (ILAE) classification categorizes HS into three types, plus 'gliosis only'.
- Detailed associations between clinical/electrophysiological findings and HS types are not well-established.
Purpose of the Study:
- To investigate the correlation between HS ILAE types and clinical/EEG findings in MTLE patients with HS.
- To explore potential differences in clinical features and outcomes based on HS classification.
Main Methods:
- Retrospective analysis of 48 MTLE patients who underwent temporal lobectomy with amygdalohippocampectomy.
- Classification of patients into five groups: HS ILAE types 1, 2, 3, focal cortical dysplasia type IIIa (FCD type IIIa), or gliosis/no HS.
- Correlation analysis of HS types with epilepsy duration, onset age, semiological findings, EEG data, family history, and seizure history.
Main Results:
- No association was found between HS types and epilepsy duration, onset age, semiological findings, or EEG characteristics.
- Family history of epilepsy and severe generalized tonic-clonic seizures (SGTCSs) were more frequent in patients with HS types 2 and 3.
- Status epilepticus was more frequent in patients with HS-FCD type IIIa.
Conclusions:
- HS types 2 and 3 are associated with a higher frequency of SGTCSs, status epilepticus, and a family history of epilepsy.
- These distinctions may offer insights into the epileptogenicity and prognosis of different HS subtypes.
- Further research can refine understanding of HS classification's clinical relevance.
Background:
Hippocampal sclerosis (HS) is a common pathology in MTLE, patients may show different surgical outcomes and clinical features. The 2013 ILAE classification subdivides HS into 3 types (HS type 1: severe neuronal loss and gliosis predominantly in CA1 and CA4 regions; - HS type 2: CA1 predominant; HS type 3: CA4 predominant) and includes "gliosis only, as no-HS". The association of clinical and electrophysiological findings with different HS types has not been reported previously in detail.
Methods:
48 patients who had undergone temporal lobectomy with amygdalohippocampectomy due to mesial TLE-HS between February 2014 and February 2016 were included. The patients were divided into five groups: patients with HS ILAE type 1, HS ILAE type 2, HS ILAE type 3, FCD type IIIa, or gliosis/no HS. The correlation between HS ILAE types and clinical/EEG findings in patients with MTLE due to HS was investigated.
Results:
Of the 48 patients 30 were male. In 23 patients, the resection was on the left side (48%). Three patients had only gliosis, 25 patients had HS ILAE type 1, 7 had HS ILAE type 2, and 4 had HS ILAE type 3. Nine of the 48 patients had cortical lamination abnormalities in the temporal lobe associated with HS (FCD type IIIa). All patients were seizure free for early follow up. There was no association between type of HS in terms of duration of epilepsy, onset age of epilepsy, lateralized or localized semiological findings, or interictal/ictal EEG findings. Family history of epilepsy or SGTCSs were statistically more frequent in patients with types 2 and 3 HS and status epilepticus was more frequent in patients with HS-FCD type IIIa.
Conclusion:
The patients with HS types 2 and 3 have more frequent SGTCS or status epilepticus as well as increased family history of epilepsy. These findings can be helpful in understanding the epileptogenicity-prognoses of HS.
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