Non-lesional mesial temporal lobe epilepsy

Among 29 patients with non-lesional MRI and mesial temporal lobe seizure onset recorded during stereo-EEG (SEEG) evaluation, four patients with unilateral preimplantation hypothesis had independent bilateral mesial temporal seizures on SEEG despite unilateral non-invasive evaluation data. Three of these patients were treated with a bitemporal responsive neurostimulation system(RNS). Independent bilateral mesial temporal seizures have been confirmed on RNS ECoG (electrocorticography). The fourth patient underwent right anterior temporal lobectomy.

Perven et al. propose that patients with non-lesional mesial temporal lobe epilepsy would benefit from bilateral invasive evaluation of mesial temporal structures to predict those patients who would be at most risk for surgical failure. Neurostimulation could be an initial treatment option for patients with independent bitemporal seizure onset ¹⁾.

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Perven G, Podkorytova I, Ding K, Agostini M, Alick S, Das R, Dave H, Dieppa M, Doyle A, Harvey J, Lega B, Zepeda R, Hays R. Non-lesional mesial temporal lobe epilepsy requires bilateral invasive evaluation. Epilepsy Behav Rep. 2021 Mar 27;15:100441. doi: 10.1016/j.ebr.2021.100441. PMID: 33898964; PMCID: PMC8058515.