Mesial temporal lobe epilepsy – symptomatic epilepsy with partial complex seizures caused by hippocampal mesial sclerosis

We report on a good outcome of neurosurgical treatment in a 17-year-old male suffering from drug resistant epilepsy with complex partial seizures. The data on his mother’s pregnancy and delivery as well as on his later psychomotor and intellectual development were normal. The patient had normal neurologic finding from early follow up on. Febrile convulsions occurred three times in infancy. Since he was 4 years old, he had very frequent seizures preceded by epigastric aura and characterized by vegetative symptoms, automatisms and masticatory pantomime. Seizures persisted for years with secondary generalization several times per year despite mono- and polytherapy with all antiepileptic drugs available. After 13 years of unsuccessful treatment with antiepileptic drugs, advantages and complications of neurosurgical treatment were explained to the patient and his parents, emphasizing that neurosurgical treatment leads to seizure freedom in more than 70% of patients suffering from temporal lobe epilepsy. The data obtained by thorough preoperative diagnostics were congruent with the clinical semiology in our patient and subtemporal left osteoplastic craniotomy was performed together with selective amygdalohippocampectomy. Sclerotic left hippocampus with uncus and left entorhinal cortex was removed. Postoperative follow up was without complications. Eight months after neurosurgery the patient is still seizure-free. Seizure freedom improved the quality of his life. We expect a good long-term outcome of the neurosurgical treatment and discontinuation of antiepileptic therapy.