Abstracts

RATIONALE: Mesial temporal lobe epilepsy is well known clinical syndrome in terms of electro- clinico- pathological point of view. However, there are no plasuable preceding causes leading to MTS except for the history of febrile convulsion. Occasionally, we have met intractable epilepsy patients with MTS and only a history of CNS infection. We investigated the clinical profiles of MTLE patients with CNS infection as another cause of MTS to delineate the clinical differences between conventional MTLE and MTLE due to preceding CNS infection.
METHODS: Clinical data of temporal lobe epilepsy patients with unilateral MTS in MRI were thoroughly reviewed from patients registered at Yonsei University Severance Hospital for last 12 years. T1 axial and T2 weighted oblique coronal image including FLAIR image were taken for evaluation of hippocampal morphology. Cases with clear unilateral MTS without additional lesions in MRI were divided into cryptogenic (conventional) MTLE group and symptomatic (CNS infection related) MTLE. We compared the clinical data including sex, age onset, semiology, frequency of seizure, laterality of MTS, whether or not the presence of secondarily generalized seizure, and prognosis. We decided the prognosis to be poor if the reduction of seizure frequency was less than half and good if seizure free or aura only.
RESULTS: Total enrolled cases were 126 in cryptogenic MTLE and 22 in symptomatic MTLE group. Conventional cryptogenic MTLE showed statistically significant preponderance (P [lt] 0.05) in febrile convulsion and accompaniment of 2[ssquote] GTC. In contrast, symptomatic MTLE revealed statistically significant higher (P [lt] 0.05) in male preponderance, family history, daily attack, and nocturnal GTC. Clinical semiology including aura and automatism was not different between two groups and also overall prognosis was same with more than 5 years follow up duration.
CONCLUSIONS: Our data showed prominent preponderance of febrile convulsion in conventional MTLE group as expected, but family history was not. In consideration of no differences of ictal semiology such as aura and automatism in spite of minor differences as above results, the mesial temporal location of ictal onset does not seem to have an effect on the semiology depending on the underlying etiology.