Mesial temporal sclerosis (II): clinical features and complementary studies

OBJECTIVE: To collect clinical data and diagnostic characteristics of the mesial temporal sclerosis syndrome (MTS). Development. CLINICAL FEATURES: In MTS repeated temporal lobe seizures, difficult to control pharmacologically, are seen in patients with neuropsychological defects which can be shown by appropriate tests. There is no pathognomonic clinical data. However, there is frequently: 1. Onset of seizures during childhood (6-10 years old). 2. Presence of some type of aura. The only significantly related types are visceral, olfactory and uncinate. 3. A pattern of conduct typical of ictus, although this is nonspecific: Early ipsilateral manual automatism and contralateral tonic posture. 4. Infrequent generalization. Surface EEG: Acute elements and/or slow waves in interictal recordings localized to the anterior temporal region, either unilateral or bilateral and with independent expression. MR of encephalum: Two typical ipsilateral findings at the electric focus of independent presentation and not mutually exclusive: a) Hippocampal hyperdensity in T2 sequences. b) Atrophy of hippocampal structures. FDG-PET: Interictal pattern of ipsilateral temporal hyperperfusion with typical maximal involvement of the polar region. SPECT-HMPAO: Early ictal and post-ictal pattern of ipsilateral temporal hyperperfusion. CONCLUSIONS: MTS is a clinical syndrome with its own identity from the clinical and diagnostic point of view. Results of the non-invasive tests currently available make invasive tests unnecessary in the preoperative guidelines for these patients.