[Mesial temporal lobe epilepsy: its physiopathology, clinical characteristics, treatment and prognosis].

Abstract

INTRODUCTION: The prevalence of epilepsy in the population is between 15 and 18 per 1000. About 60 to 80% of the people affected are considered to have an appropriate long term prognosis (from 5 to 10 years), while between 20 and 40% respond partially to pharmacological therapy. Temporal lobe epilepsy (TLE) is the main cause of refractory epilepsies and is associated to atrophy and sclerosis of the hippocampus. Aims. To determine the physiopathology, clinical characteristics, modes of therapy and prognosis of TLE through a survey of the literature. DEVELOPMENT: The physiopathology of this disease is unknown but early brain injury, with ensuing neuronal death and loss, triggered by mechanisms of excitotoxicity has been put forward as an explanation. TLE presents a clinical picture, which is heterogeneous in childhood and homogeneous in adulthood, that is characterised by the presence of simple partial seizures and complex partial seizures. These seizures can become generalised. Diagnosis is based on the results from the electroencephalogram and from the cranial magnetic resonance, which is currently considered to be the standard diagnostic method. The pharmacological treatment of TLE only achieves complete control over the seizures in less than 20% of patients. Surgical methods, such as anterior temporal lobectomy and amygdalohippocampectomy, reach control rates in 67 85% of patients, with low morbidity and mortality rates. Although prognosis depends on a number of factors, surgical treatment improves the quality of life of these patients.