Clinical characteristics in patients with hippocampal sclerosis with or without cortical dysplasia.

BACKGROUND: Mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS) constitutes a distinct clinical syndrome with variable pathogenesis. Extrahippocampal regions may be affected in MTLE/HS, association with cortical dysplasia is common and temporal polar cortex is frequently involved in seizure onset. Patients with dual pathology may have favourable outcome from the surgery provided that both pathologies are removed. The aim of the study was to review clinical variables of MTLE/HS patients in order to distinguish preoperatively patients with associated microscopic cortical dysplasia in the temporal pole.
METHODS: A series of 38 patients with the clinical diagnosis of MTLE and histopathologically proven HS were analysed. Patients were divided into two groups on the basis of histopathological finding in the temporal polar cortex: HS associated with malformation of cortical development (group HS+, n = 19) and a group with isolated HS (group HS, n = 19). Demographic, clinical, electrographic and seizure semiology variables were obtained and their prevalence compared between both groups.
RESULTS: At least one insult was identified in early childhood history of 18 patients in the HS group in comparison to 10 patients in the HS+ group (p < 0.01). Complicated febrile seizures were found in both groups with similar prevalence, the history of early childhood CNS infection prevailed in the HS group (p < 0.01). Absence of aura was reported in HS group only. Patients in the the HS+ group had earlier surgery (p < 0.05) but the seizure outcome was comparable between groups.
CONCLUSIONS: Microscopic dual pathology is common in MTLE/HS patients. This group of patients is difficult to distinguish preoperatively on the basis of noninvasive electrographic features or ictal clinical semiology. Detailed information regarding the possible precipitating insult in the history may be of critical importance.