Hippocampal atrophy detected by MRI volumetry has 75% sensitivity, and 64% specificity for ipsilateral medial temporal lobe seizure. Image above shows a hyperintensities of right hippocampus on MRI FLAIR sequence, compared with the left (black arrows) which is normal. This is an image of left mesial temporal sclerosis. Image above shows the hyperintensity of left hippocampus on MRI FLAIR sequence. These were said to be secondary because of the indirect consequences of hippocampal atrophy. Secondary abnormalities includes unilateral fornix column, mamillary body, and amygdala atrophy.
Primary abnormalities includes unilateral hippocampal atrophy and hyperintensity of medial temporal or hippocampas. The abnormalities able to be detected by naked eyes on structural MRI can be divided into primary and secondary abnormalities. Ĭommonly used is structural MRI in helping the diagnosis along side with FLAIR sequences to enhance the images. Image above shows the EEG finding in ictal state of MTLE a lateralized rhythmic 5-7 Hz sharp activity appeared within first 30 seconds of clinical sign and symptoms. Image above shows the EEG finding during interictal state of MTLE a typical epileptiform abnormality with spike or sharp wave with negative polarity and followed by a slow wave. This characteristic rhythm occurs in about 90% of patients with MTLE and has 95% specificity for lateralizing the seizure. During ictal state, the scalp EEG will shows unilateral 5-7 Hz rhythmic discharges that appears within the first 30 seconds of the first objective or subjective clinical sign and symptoms of a seizure in anterior-inferior temporal scalp EEG. This are present in up to 94% of the patients. The characteristic EEG findings during interictal state is anterior temporal sharp waves, spikes and followed by slow waves. ĮEG used in helping the diagnosis of MTLE can be divided into interictal and ictal state. Literatures has described that unilateral dystonic posture of an arm as a localizing features is highly accurate when combined with contralateral hand’s automatism.Įlectroencephalography (EEG) of MTLE. Others include unilateral posturing, mpostictal disorientation and postictal dysphasia. In observable neurological manifestation include motor arrest, staring and automatism. Some may also unable to describe the aura, probably as a result of complex partial seizure which associated with amnesia. Less commonly, one also could experience a sense of fear, déjá vu, jamais vu, olfactory hallucinations, and sometimes depersonalization. The presentation is variable but can be divided into 2 forms, those that felt by the patients aura, and one that we can see observable neurological manifestation.ĭuring the onset of seizure, one could feel an odd raising sensation from the abdomen. MTLE is interesting and important to know because it is often intractable to medical treatment and treatable by surgical approach. Mesial temporal sclerosis (MTS) is considered a pathological substrate of MTLE. The international leagues against epilepsy (ILAE) did not include this terminology into its classification but rather used a more general term temporal lobe epilepsy.
Radiological features could help in diagnosis but is not part of the definition. It is diagnosed based on typical clinical presentation and EEG findings. Mesial temporal lobe epilepsy (MTLE) is one of the most common, in fact, the most common syndrome associated with focal seizures and cognitive impairment.
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