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Comparison of Temporal Lobe Epilepsy with Hippocampal Sclerosis and Temporal Lobe Epilepsies Due to Other Etiologies

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Comparison of Temporal Lobe Epilepsy with Hippocampal Sclerosis and Temporal Lobe Epilepsies Due to Other Etiologies Thomas Jefferson University Jefferson Digital Commons Department of Neurology Faculty Papers Department of Neurology 1-1-2015 Comparison of temporal lobe epilepsy with hippocampal sclerosis and temporal lobe epilepsies due to other etiologies. A A Asadi-Pooya Department of Epileptology, Research Center for Traditional Medicine and History of Medicine, Shiraz, University of Medical Sciences; Department of Neurology, Thomas Jefferson University Marziyeh Tajvarpour Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences Bahareh Vedadinezhad Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences Mehrdad Emami Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences Follow this and additional works at: https://jdc.jefferson.edu/neurologyfp Part of the Neurology Commons Let us know how access to this document benefits ouy Recommended Citation Asadi-Pooya, A A; Tajvarpour, Marziyeh; Vedadinezhad, Bahareh; and Emami, Mehrdad, "Comparison of temporal lobe epilepsy with hippocampal sclerosis and temporal lobe epilepsies due to other etiologies." (2015). Department of Neurology Faculty Papers. Paper 98. https://jdc.jefferson.edu/neurologyfp/98 This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Neurology Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, please contact: [email protected]. Original Article http://mjiri.iums.ac.ir Medical Journal of the Islamic Republic of Iran (MJIRI) Iran University of Medical Sciences Comparison of temporal lobe epilepsy with hippocampal sclerosis and temporal lobe epilepsies due to other etiologies Ali A. Asadi-Pooya*1, Marziyeh Tajvarpour2, Bahareh Vedadinezhad3 Mehrdad Emami4 Received: 12 March 2015 Accepted: 2 June 2015 Published: 13 September 2015 Abstract Background: This study compares the clinical characteristics of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) with those who have temporal lobe epilepsy (TLE) due to other etiologies. Methods: In this retrospective study all patients with a clinical diagnosis of TLE were recruited in a referral outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 to May 2013. We classified the patients with TLE as having mesial temporal sclerosis if they had clear signs of mesial temporal sclerosis and/or atrophy in their MRI and others who had any other MRI abnormality. Results: A total of 174 patients were studied (including 105 patients with mTLE-HS and 69 pa- tients with TLE due to other etiologies). Frequency of seizure types was not significantly different between these two groups. Earlier age at epilepsy onset (p= 0.005), a past history of febrile seizures (p= 0.010) and presence of affective auras (p= 0.008) were commonly seen in patients with mTLE- HS, while auditory auras (p= 0.020) were more frequent in those with TLE due to other etiologies. Conclusion: The mainstay for making a correct diagnosis, when evaluating a patient with seizure, is having a standardized approach, particularly with regard to taking a detailed clinical history. One may find important clues in the clinical history (e.g., age at disease onset, detailed seizure description and past history) to make a correct diagnosis. Keywords: Age; Aura; Febrile seizure; Temporal lobe epilepsy; Hippocampal sclerosis. Cite this article as: Asadi-Pooya A.A, Tajvarpour M, Vedadinezhad B, Emami M. Comparison of temporal lobe epilepsy with hippocam- pal sclerosis and temporal lobe epilepsies due to other etiologies. Med J Islam Repub Iran 2015 (13 September). Vol. 29:263. Introduction gical treatment; it is often refractory to an- Focal epilepsies account for about two- tiepileptic drugs (AEDs), but responds fa- thirds of all adult epilepsy patients, and vorably to surgery (1,4). Patients with temporal lobe epilepsy (TLE) is the most mTLE-HS and intractable seizures often common type of focal epilepsy (1,2). Tem- experience progressive behavioral changes poral lobe epilepsy is subcategorized as including increasing memory deficit with mesial (i.e., amygdalohippocampal) and the passage of time. In addition, surgical neocortical (i.e., lateral) temporal. Mesial outcome may be worse with longer dura- temporal sclerosis is the most common tion of epilepsy or increasing age at sur- pathological substrate of TLE (1,3). Mesial gery, which suggests that mTLE-HS is a temporal lobe epilepsy (mTLE) with hip- progressive disorder (5). Therefore, early pocampal sclerosis (HS) is one of the most detection of this syndrome and its distinc- common types of epilepsy referred for sur- tion from other TLE syndromes has im- ____________________________________________________________________________________________________________________ 1. (Corresponding author) MD, Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences, & Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, & Jefferson Comprehensive Epilepsy Center, De- partment of Neurology, Thomas Jefferson University, Philadelphia, USA. [email protected] 2. MD, Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. [email protected] 3. MD, Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. [email protected] 4. MD, Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. [email protected] Temporal lobe epilepsy portant practical implications with regard to positive family history of epilepsy), EEG planning an optimal treatment strategy for findings (the most informative EEG), and the affected patient. MRI findings of all patients were registered In the current study, we tried to compare routinely. Seizure types were categorized as the clinical characteristics of patients with generalized tonic clonic seizures (GTCS), mTLE-HS with those who had TLE due to complex partial seizures (CPS) and auras. Pa- other etiologies in order to identify poten- tients with concomitant psychogenic non- tially differentiating clinical characteristics epileptic seizures (PNES) were excluded. between these two groups of patients. Demographic variables and relevant clin- ical variables were summarized descriptive- Methods ly to characterize the study population. In this retrospective analytic study all pa- Pearson Chi-Square, Fisher's Exact, and tients with a clinical diagnosis of TLE were Mann-Whitney U tests were used for statis- recruited in an outpatient epilepsy clinic at tical analyses. P value less than 0.05 was Shiraz University of Medical Sciences, considered as significant. This study was which is the only referral epilepsy clinic in approved by Shiraz University of Medical south Iran. This study was conducted from Sciences Review Board. September 2008 to May 2013. The diagno- sis of TLE was made exclusively by one Results epileptologist working at this institution Until May 2014, 2890 patients with epi- (the first author) and based on clinical lepsy were registered at our epilepsy clinic. grounds (semiology), electroencephalo- Four hundred twenty-seven patients graphic (EEG) findings and imaging, such (14.7%) were diagnosed as having TLE. Of as magnetic resonance imaging (MRI). All these, 174 patients were eligible to enter the patients were followed up by the epileptol- study (105 patients with mTLE-HS and 69 ogist at our institution for at least one year patients with TLE due to other etiologies). (i.e., until May 2014). There was no age Demographic and clinical characteristics of limit to enter the study. Routine EEG was patients with mTLE-HS and those who had requested for all patients at the time of re- TLE due to other etiologies are shown and ferral. In difficult-to-diagnose or difficult- compared in table 1. Frequency of seizure to- treat patients we often order video-EEG types (i.e., GTCS vs. CPS vs. auras) was monitoring to ascertain the diagnosis and not significantly different between these formulate an individualized treatment plan, two groups (Table 1). Specific types of au- accordingly. For all patients, a 1.5 Tesla ras were significantly different between brain MRI (epilepsy protocol) was per- these two groups (Table 1), however most formed. auras were reported by both groups, simi- Patients with normal MRI were excluded larly. Epilepsy risk factors were reported to from this study. We classified patients as be as follows (mTLE-HS vs. others): paren- having MTS (if they had clear signs of me- tal consanguinity in 41 / 30 (p= 0.6), family sial temporal sclerosis and/or atrophy in history of epilepsy in 18 / 10 (p= 0.6), sig- their MRI) and those who had any other nificant head trauma in 15 / 7 (p= 0.4), MRI abnormality. Patients with dual pa- CNS infection in 2 / 2 (p= 0.6) and preg- thology (i.e., mesial temporal sclerosis as- nancy
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