The diagnosis of mesial temporal sclerosis includes detailed history and physical examination. A history of a prolonged seizure with fever in early life can be a risk factor for development of MTS.
SPECT and PET imaging are also a useful adjuncts, with both ictal and inter-ictal scans demonstrating abnormalities
ictal scan: hyper perfusion
interictal scan: hypo perfusion
Other causes of temporal lobe epilepsy (TLE) should be considered, especially as small temproal lobe cortical tumours can have similar appearances.