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Hippocampal sclerosis (HS) or mesial temporal sclerosis (MTS) is a neuropathological condition with severe neuronal cell loss and gliosis in the hippocampus. [1] Neuroimaging tests such as magnetic resonance imaging (MRI) and positron emission tomography (PET) may identify individuals with hippocampal sclerosis. [ 2 ]
Identification of common lesions associated with epilepsy like focal cortical dysplasia, mesial temporal sclerosis, microencephalocele, and heterotopia require thorough review of images by trained clinicians as the changes can be very subtle and easily missed if not specifically evaluated for.
They most commonly arise from the mesial temporal lobe, particularly the amygdala, hippocampus, and neocortical regions. [17] A common associated brain abnormality is mesial temporal sclerosis. [15] Mesial temporal sclerosis is a specific pattern of hippocampal neuronal loss accompanied by hippocampal gliosis and atrophy. [18]
Nearly all reports of seizure outcome following these procedures indicate that the best outcome group includes patients with MRI evidence of mesial temporal sclerosis (hippocampal atrophy with increased T-2 signal). The range of seizure-free outcomes for these patients is reported to be between 80% and 90%, which is typically reported as a sub ...
Temporal lobe epilepsy is the most common focal onset epilepsy, and 80% of temporal lobe epilepsy is mesial (medial) temporal lobe epilepsy, temporal lobe epilepsy arising from the inner part of the temporal lobe that may involve the hippocampus, parahippocampal gyrus or amygdala.
Hippocampal sclerosis involves neural loss and a selective mesial temporal sclerosis (MTS) danger and is likely caused by an overactivation of N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors by the surplus signaling of excitatory neurotransmitters. [9]
The type of surgery depends on the location of the seizure focal point. Surgeries for epilepsy treatment include, but are not limited to: temporal lobe resection, hemispherectomy, ground temporal and extratemporal resection, parietal resection, occipital resection, frontal resection, extratemporal resection, and callosotomy. [20] [21]
Hippocampal sclerosis including Ammon's horn sclerosis that is specific to the mesial temporal lobe, is the most common type of such tissue damage. [ 129 ] [ 130 ] It is not yet clear, however, whether the epilepsy is usually caused by hippocampal abnormalities or whether the hippocampus is damaged by cumulative effects of seizures. [ 131 ]
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