Abstracts

Rationale: Mesial temporal sclerosis (MTS) is the most common pathological lesion in patients with medial temporal lobe epilepsy. Altough bilateral typical MTS is unusual, pathological series have shown that MTS is present bilaterally to some extent in %72-90. In this study, we documented 80 patients with typical bilateral MTS to identify a distinct clinical entity. Methods: Types of seizures, age of onset, perinatal insults, and history of febrile convulsion or status epilepticus, interictal and/or ictal scalp EEGs were evaluated. All patients were submitted to MRI, in some cases MRS and SPECT were performed. Results: There are 80 patients (43 female, 37 male). Mean age is 35.05 (±12.6) and mean age at seizure onset is 12.4 (±11.3). Auras were documented in 55 patient automotor seizures were documented in 54 patients and secondarily generalized seizures were seen 41 patient. Mean seizure number was 8.1 (± 10.9) per month. A history of febrile convulsions (FC) is reported in 7 patients; perinatal trauma in 17 patients; and head trauma in 10 patients. Eleven patients have history of CNS infection. Status epilepticus was seen in 18 patients. Psychosis and depression were documented in 12 patients. Family history of seizure was documented in 28 patients. Interictal EEGs revealed unilateral (7 right, 4 left) or bilateral (14) temporal discharges, right (12) and left (23) frontotemporal discharges. Vagal nerve stimulation was applied to one patient and 9 patients went on amygdalohippocampectomy. Automotor seizures were the refractory to the treatment in comparison to focal motor and/or secondarily generalized seizures. Conclusions: Refractory automotor seizures with neurobehavioral abnormalities are clinical characteristics of bilateral MTS. While FC is not a prominent finding, brain insults (perinatal injury, head trauma or status epilepticus) are important in the pathogenesis of bilateral MTS.