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Causes, presentation and outcome of lesional adult-onset mediotemporal lobe epilepsy
  1. Bettina M Soeder (bmsoeder{at}gmx.de)
  1. University of Bonn, Dept. of Epileptology, Germany
    1. Ulrike Gleissner (ulrike.gleissner{at}lvr.de)
    1. University of Bonn, Dept. of Epileptology, Germany
      1. Horst Urbach (horst.urbach{at}ukb.uni-bonn.de)
      1. University of Bonn, Dept. of Radiology/Neuroradiology, Germany
        1. Hans Clusmann (hans.clusmann{at}ukb.uni-bonn.de)
        1. University of Bonn, Dept. of Neurosurgery, Germany
          1. Christian E Elger (christian.elger{at}ukb.uni-bonn.de)
          1. Department of Epileptology, Germany
            1. Angela Vincent (avincent{at}hammer.imm.ox.ac.uk)
            1. Neurosciences Group, Weatherall Institute of Molecular Medicine, University of Oxford, United Kingdom
              1. Christian G Bien (christian.bien{at}ukb.uni-bonn.de)
              1. University of Bonn, Germany

                Abstract

                Purpose: Mediotemporal lobe (MTL) epilepsy (MTLE) is particularly frequent among human localization-related epilepsies. MTLE usually starts before adulthood and is most frequently associated with hippocampal sclerosis (HS). For lesional adult-onset MTLE, aetiologies, disease courses, and outcomes are unknown.

                Methods: From the database of this centre, we collected all patients studied between 01/1999-12/2005 fulfilling the following criteria: (1) MTLE manifestation at age >20 years; (2) time between disease manifestation and assessment ≤6 years; (3) MTL lesion on brain MRI; (4) neuropsychological test battery applied. We classified the diagnoses and documented the paraclinical data, neuropsychological performances, and seizure and memory outcomes.

                Results: Diagnoses in the 84 patients (mean age 42 years at MTLE onset) were: limbic encephalitis (LE), N=23 (27%); HS (unrelated to inflammation), N=18 (22%); tumours I/II°, N=12 (14%); amygdala lesions (increased volume and T2/FLAIR signal), N=11 (13%); other, N=20 (24%). Visible MTL affection was frequently bilateral in LE (57%) and HS (22%) patients. These groups also showed the poorest memory performance. Patients with amygdala lesions were the oldest ones (mean age 52 years); aetiology of their lesions is unclear. Treatment-dependent seizure outcomes were similar to published data without restriction to adult onset-cases. Under conservative therapy, memory performance remained stable in HS patients but improved in a proportion of LE patients.

                Conclusions: The most frequent cause of lesional MTLE in young adults is LE. Its prognosis in terms of seizure and memory outcome is variable. The aetiology of amygdala lesions awaits clarification - encephalitis and dysplastic lesions are most probable candidates.

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