Uncommon lesions in the medial temporal lobe presenting with intractable epilepsy

Introduction: Medial temporal lobe is a major site of seizure origin. Lesions present in the medial temporal lobe might predominantly present with epilepsy which might even be refractory to anti-epileptic drugs. We describe 8 uncommon lesions involving the medial temporal lobe which presented with intractable seizures.

Material and methods: 8 patients were included in the study from July, 2014 to July, 2015 who had presented to a tertiary care centre with seizures which were not controlled on medications. Complete clinical and radiological assessment of these cases was done. Treatment received and the seizure outcome (Engel's grade) were also noted.

Results: 6 cases presented with complex partial seizures out of which 5 had olfactory auras. 5 patients had right sided lesions and remaining 3 had left sided lesions. Among these 8 cases, 2 were tuberculomas and cavernomas each, 1 was epidermoid, 1 was ganglioglioma and 1 was a low grade glioma. All patients had a complete excision of the concerned lesion. Anterior medial temporal lobe resection (including amygdale and hippocampal resection) was performed in all these cases. 7 cases had Engel grade 1 seizure control and 1 had Engel grade 2 seizure control. No significant post-operative complication occurred in any of the patients.

Conclusion: Medial temporal lobe may harbour various pathologies and due to its location, it predisposes the patient for seizures. Lesionectomy when combined with AMTR gives good seizure control.