Limbic system abnormalities associated with mesial temporal sclerosis: a model of chronic cerebral changes due to seizures

In a landmark 1966 study, widespread cerebral abnormalities were discovered at histopathologic examination of autopsied brains from patients with long-standing temporal lobe epilepsy. In the brains diagnosed with mesial temporal sclerosis (MTS), these abnormalities involved not only the hippocampus but also other structures of the limbic system and medial temporal lobe. Many of these changes are evident at magnetic resonance imaging. Because many of these abnormalities are found within limbic structures along a known neuroanatomic pathway (the Papez circuit), they suggest a pattern of cerebral damage related to the physiologic interconnections between the hippocampus and associated limbic structures. It appears that limbic damage associated with MTS more often affects the structures most closely connected to the hippocampus along the Papez circuit. The frequency and widespread distribution of these cerebral abnormalities suggest that MTS is not limited to the medial temporal lobe but instead represents a limbic system disorder.