Temporal pole blurring in temporal lobe epilepsy revealed by 3D Edge-Enhancing Gradient Echo MRI

While abnormalities of the hippocampus have been well characterized in temporal lobe epilepsy, various additional temporal lobe abnormalities have also been described. One poorly understood entity, the so-called temporal pole blurring (TPB), is one of the more frequently described neocortical abnormalities in TLE and is thought to represent dysmyelination and axonal loss due to chronic electrical perturbations in early age-onset temporal lobe epilepsy. In this study, we describe the first reported cases of TPB diagnosed by a recently described MRI sequence known as 3D Edge-Enhancing Gradient Echo (3D-EDGE), which has an effective “myelin weighting” making it exquisitely sensitive to this temporal pole dysmyelination. The value of detection of TPB lies in lateralizing seizure onset, as well as predicting a lower baseline neuropsychological performance compared to temporal lobe epilepsy without TPB. Additionally, it is critical to not mistake TPB for alternative diagnoses, such as focal cortical dysplasia or neoplasm.

Download Full-text

Focal Cortical Dysplasia in Temporal Lobe Epilepsy

Magnetic Resonance Scanning and Epilepsy ◽

10.1007/978-1-4615-2546-2_20 ◽

1994 ◽

pp. 111-116

Author(s):

R. Kuzniecky

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia

Download Full-text

Multiple hippocampal transections for mesial temporal lobe epilepsy

Surgical Neurology International ◽

10.25259/sni_350_2021 ◽

2021 ◽

Vol 12 ◽

pp. 372

Author(s):

David Pitskhelauri ◽

Elina Kudieva ◽

Maria Kamenetskaya ◽

Antonina Kozlova ◽

Pavel Vlasov ◽

...

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Verbal Memory ◽

Visual Memory ◽

Focal Cortical Dysplasia ◽

Mesial Temporal Lobe Epilepsy ◽

Drug Resistant ◽

Preoperative Level ◽

Temporal Pole ◽

Mesial Temporal Lobe

Background: The purpose of this study was to evaluate the effectiveness of multiple hippocampal transections (MHT) in the treatment of drug-resistant mesial temporal lobe epilepsy. Methods: Six patients underwent MHT at Burdenko Neurosurgery Center in 2018. The age of the patients varied from 18 to 43 years. All patients suffered from refractory epilepsy caused by focal lesions of the mesial temporal complex or temporal pole in dominant side. Postoperative pathology revealed neuronal-glial tumors in two patients, focal cortical dysplasia (FCD) of the temporal pole – in two patients, cavernous angioma – in one patient, and encephalocele of the preuncal area – in one patient. Results: All patients underwent surgery satisfactorily. There were no postoperative complications except for homonymous superior quadrantanopia. This kind of visual field loss was noted in four cases out of six. During the follow-up period five patients out of six had Engel Class I outcome (83.3%). In one case, seizures developed after 1 month in a patient with FCD in the uncus (Engel IVA). After surgery, three out of six patients developed significant nominative aphasia. Two patients relative to the preoperative level demonstrated improvement in delayed verbal memory after MHT. Two patients showed a decrease level in delayed verbal memory. In preoperative period, visual memory was below the normal in one patient. Delayed visual memory in two cases impaired compared to the preoperative level. Conclusion: MHT can be considered as an effective method of drug-resistant mesial temporal lobe epilepsy caused by tumors of the medial temporal complex. At the same time, MHT makes it possible to preserve memory in patients with structurally preserved hippocampus. However, MHT do not guarantee the preservation of memory after surgery.

Download Full-text

Neuropathology of Temporal Lobe Epilepsy

Epilepsy Research and Treatment ◽

10.1155/2012/624519 ◽

2012 ◽

Vol 2012 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Fahd Al Sufiani ◽

Lee Cyn Ang

Keyword(s):

Temporal Lobe Epilepsy ◽

Temporal Lobe ◽

Focal Cortical Dysplasia ◽

Cortical Dysplasia ◽

Wide Range ◽

Pathologic Findings ◽

Pathologic Lesions ◽

Recent Classification ◽

Associated Tumors

Pathologic findings in surgical resections from patients with temporal lobe epilepsy include a wide range of diagnostic possibilities that can be categorized into different groups on the basis of etiology. This paper outlines the various pathologic entities described in temporal lobe epilepsy, including some newly recognized epilepsy-associated tumors, and briefly touch on the recent classification of focal cortical dysplasia. This classification takes into account coexistent pathologic lesions in focal cortical dysplasia.

Download Full-text