Benign mesial temporal lobe epilepsy: A clinical cohort and literature review

- RESULTS Over the duration of the observation window, a total of 27 patients were identified. In our appraisal of the early records, we found that the diagnosis of TLE was always based upon the patient's clinical features, MRI and EEG, with the diagnostic criteria used similar to those described in the literature 14,15.
- Seizures were clinically mild in all 27 patients at presentation, being either viscerosensory or associated with experiential auras in 22 patients (Table 2). On Highlights (for review) baseline examination in the Epilepsy Clinic, however, all were neurologically and cognitively normal, and no patients reported notable memory loss since the onset of their seizures.
- The AED most commonly used was carbamazepine, which was still being taken by the majority of patients. Other drugs used as mono-therapy were oxcarbazepine, phenytoin, valproic acid, and lamotrigine. In the fourth patient, who at one point was placed on two drugs, the primary issue was drug intolerance, both to higher doses of a single drug and to the use of multiple drugs. Her seizures generally consisted of an epigastric sensation that could last for hours, rarely progressing to a dyscognitive seizure with impaired awareness. At one point, she was admitted to the Epilepsy Monitoring Unit for pre-surgical assessment, though she herself was not interested in surgery, despite the presence of MTS on MRI. Most of her daily symptoms were attributed to medication side effects from polypharmacy. Ultimately, her seizures were controlled with low-dose phenytoin.
- None of the patients underwent surgery to treat epilepsy. - - Clearly, not all temporal lobe epilepsy is refractory to medication, even when MTS is present. However, until clinical trials suggest otherwise, long-term if not indefinite drug treatment appears most prudent, as surgical treatment is not indicated for bMTLE

ObjectiveWe present a single-center retrospective study of benign mesial temporal lobe epilepsy (bMTLE) between 1995 and 2014.MethodsHospital records and clinic charts were reviewed. The clinical, Eelectroencephalographic (EEG), imaging features, and response to treatment with antiepileptic drugs (AEDs) were documented. Patients were included in this study if they were seizure-free for a minimum of 24 months with or without an AED.ResultsTwenty-seven patients were identified. There were 19 (70%) females, mean age at first seizure was 32.2 (range: 15-80 years). In all patients, seizures were mild, and seizure freedom was readily achieved with the initiation of AED therapy. Sixteen patients (59%) had mesial temporal sclerosis (MTS). In three patients, we attempted to discontinue AED therapy after a prolonged period of remission (5-8 years), but all had seizure recurrence within 2 to 4 weeks.SignificanceNot all temporal lobe epilepsy is refractory to medication, despite the presence of MTS. Until clinical trials indicate otherwise, surgery is not indicated but life-long medical treatment is advocated.