Clinical History and Surgical Intervention for Temporal Lobe Epilepsy with Hippocampal Sclerosis: A Case Study

Bruno Silva Costa

Chairman, Neurosurgery Department, Santa Casa Hospital, Brazil

Abstract:

This article presents a case study of a 32-year-old patient with drug-resistant temporal lobe epilepsy caused by right hippocampal sclerosis. The patient's clinical history includes recurrent seizures characterized by loss of contact, chewing movements, facial automatism, and left upper limb hypertonia. Despite various antiepileptic medications, the symptoms persisted, accompanied by mild cognitive deficits. Diagnostic evaluations revealed marked right hippocampal atrophy and interictal epileptic discharges in the bilateral temporal regions. The patient underwent non-selective right amygdalo-hippocampectomy, resulting in a significant improvement in cognitive functioning post-surgery. The article discusses the rationale behind surgical intervention and potential complications. The findings highlight the effectiveness of surgical treatment for temporal lobe epilepsy due to hippocampal sclerosis and the need for individualized approaches in choosing the surgical technique.

Clinical history.

A 32-year-old patient presents with convulsive seizures characterized by loss of contact, chewing movements and facial automatism, as well as hypertonia of the left upper limb. Four episodes per month. Often the episode is preceded by a feeling of fear and epigastric discomfort. The neurological examination shows only a certain slowness in the execution of daily tasks, without focal neurological deficits, with a preserved memory. He is taking lamotrigine 300mg daily, oxcarbazepine 1800mg daily and clobazam 20mg daily without adequate monitoring. He presented with generalized febrile seizures at age 2 years, treated with phenobarbital with adequate control and discontinued at age 4 years. At the age of 16, he began to exhibit the current symptoms. He has been treated with carbamazepine, phenytoin, topiramate before, with no resolution of the chart.

Propaedeutics

He underwent a brain MRI which showed atrophy of the right hippocampus suggestive of hippocampal sclerosis. In-unit video-EEG monitoring for 72 hours showed an interictal pattern of spines in the bilateral temporal regions. Two electroencephalographic seizures with onset in the right anterior temporal region. Neuropsychological evaluation shows mild cognitive deficit, preserved verbal memory, and moderate loss of nonverbal memory.