A history of mesial temporal sclerosis and its treatment

Bijal K. MEHTA and Edward J. FINE
Neurology, Department of Veterans' Affairs Medical Center, Buffalo, New York, USA and Department of Neurology, School of Medicine and Allied Health, State University of New York, Buffalo, USA.   bmehta AT buffalo.edu     efine AT buffalo.edu

Mesial temporal sclerosis (MTS) was first noted by Bouchet and Cazauvieihl in 1825. They described 9 patients with changes to Ammon's Horn, which they later called Ammon's Horn Sclerosis, as the source for those patientsí epilepsy. Sommer in 1880 first described the microscopic pathology of MTS. William Gowers and later Wilder Penfield, doubted that this area and the lesions described by Sommer were not likely to be a source of epilepsy. Spielmeyer and Scholtz stated that the temporal lobe lesions noted by Sommer were a result of epilepsy rather than its cause. In 1935, Stauder described post-mortem findings of MTS in a group of epileptic patients in Germany.

Surgical treatment was attempted, because MTS was intractable to medical therapy. Wilder Penfield and Richmond Paine reported that removal of "deeper" temporal lobe structures eliminated seizures in some patients who had prior superficial temporal lobe surgery. M.A. Falconer in the 1960-1970ís showed that the majority of adult patients who had spike discharges on their electroencephalograms (EEG) from their temporal lobes had MTS by histological criteria. He concluded that excision of sclerotic lesions reduced seizure recurrence. In the 1980's, Turner and Wyler showed that complete temporal lobectomy was effective treatment for temporal lobe epilepsy due to MTS.

As neuro-imaging technology improved, diagnosis of MTS by computed tomography (CT) was first reported in 1 979 and by magnetic resonance imaging in 1987. Improved imaging and surgical techniques in the last 2 decades led to "reemergence" of surgical excision of the epilepsy causing lesions. Future interventional treatments for MTS and associated temporal lobe epilepsy will rely on the foundations of prior procedures and diagnostic techniques.

Session III.  Neurology
Wednesday, 20 June 2007, 3:00 - 3:30 pm

12th Annual Meeting of the International Society for the History of the Neurosciences   (ISHN)
Los Angeles, California, USA, 19-23 June 2007