Esclerosis temporomesial en adultos: revisión del síndrome y evalución de resultados / Mesial temporal sclerosis in adults: Revision of the syndrome and assessment of results

ABSTRACT

Objective: To describe the presentation and the management of the Mesial Temporal Sclerosis (ETM) in adult patients and to evaluate the results of the presented series. Description: the authors selectioned 3 cases among 53 adults who underwent surgical treatment with ETM diagnosis. Case 1: female patient, 32 years old. Antecedents of complex partial crisis since 6 years old, some of the crisis related to febrile episodes. Aura related like unpleasent gastroesophageal sensation, break of contact, right hand dystonia, cephalic turn to right and oroalimentary and manual automatism. RMI and EEG-video: injury compatible with left ETM. Case 2: male patient, 24 years old. Antecedents of complex partial crisis since 13 years old. Breack of contact, verbal automatisms (repeats unintelligible sounds) and sensation of postictal sikness. RMI: increase of signal (FLAIR) in both hippocampus, impressing right atrophy. EEG-video with profund electrodes implanted: start of the crisis on a right mesial temporal level. Case 3: female patient, 21 years old. Antecedents of complex partial crisis since 12 years old. Complex partial crisis with bimanual and oroalimentary automatisms with an episode of generalization. RMI and EEG-video: injury compatible with right ETM. Intervention: case 1 and 2 were resolved by the realization of an anteromesial resection of Spencer. In case 3 a selective amygdalo hippocampectomy was practiced. Conclusion: ETM is the paradigm of the refractory epilepsy in an adult population. Precocious diagnosys and treatment allow to obtain a high index of cure with small amount of significant sequels.