[citation needed], Up to one third of patients with medial temporal lobe epilepsy will not have adequate seizure control with medication alone. [46] This structure provides a filter for the excitability of neurons. Mesial temporal sclerosis (MTS), also commonly referred to as hippocampal sclerosis, is the most common association with intractable temporal lobe epilepsy (TLE) 2,3,5. Animal models and clinical studies show that memory loss correlates with temporal lobe neuronal loss in temporal lobe epilepsy. Neurological and mental state Usually normal prior to seizure onset. In children with newly diagnosed epilepsy, only approximately 1% have evidence of MTS on imaging. Though they may not seem harmful, due to the fact that the individual does not normally seize, they can be extremely harmful if the individual is left alone around dangerous objects. Mesial temporal sclerosis (MTS) is a common pathologic finding in patients with temporal lobe epilepsy. During the peri-ictal phases, perfusion is increased, not only in the mesial temporal lobe but often in large parts of temporal lobe and hemisphere. The first to record and catalog the abnormal symptoms and signs of TLE was Norman Geschwind. Figure 1: A. Coronal T2 weighted, B. Coronal FLAIR. Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. Anterior temporal lobectomy is successful in 75-90% of patients with MTS. Mesial Temporal Sclerosis (MTS) is a term used to describe scarring in deep part of the temporal lobe of the brain. This study was presented as an abstract at a neuroscience conference and referenced in Ramachandran's book, Phantoms in the Brain,[69] but it has never been published in the peer-reviewed scientific press. With this type, some people do not even realize they are having a seizure and most of the time their memory from right before or after the seizure is wiped. [46], In TLE, granule cells are lost, the structure is no longer closely packed and there are changes in the orientation of dendrites. MRI is the modality of choice to evaluate the hippocampus, however dedicated TLE protocol needs to be performed if good sensitivity and specificity is to be achieved . [53] Stimulation of aberrant mossy fibre areas increases the excitatory postsynaptic potential response. Mesial temporal sclerosis (MTS) is a common pathologic finding in patients with temporal lobe epilepsy. Documented by Norman Geschwind, signs include: hypergraphia (compulsion to write (or draw) excessively), hyperreligiosity (intense religious or philosophical experiences or interests), hyposexuality (reduced sexual interest or drive), circumstantiality (result of a non-linear thought pattern, talks at length about irrelevant and trivial details). Mesial temporal sclerosis in a cohort of children with SCN1A gene mutation. However, it was not until 2001 that a scientifically sound study was carried out to examine the effectiveness of temporal lobectomy. Often, the patient cannot describe the sensations. Personality and behavioural change in temporal lobe epilepsy is seen as a chronic condition when it persists for more than three months. This seizure disorder can cause a variety of symptoms such as strange sensations, changes in behavior or emotions, muscle spasms, or convulsions.The seizures usually are localized in the brain, but they may spread to become generalized seizures, which involve the entire brain and may cause a sudden loss of awareness or consciousness. Declarative memory (memories which can be consciously recalled) is formed in the area of the hippocampus called the dentate gyrus. [citation needed], These seizures tend to have a warning or aura before they occur, and when they occur they generally tend to last only 1–2 minutes. [45][47] These changes may or may not be epileptogenic. The classification was based on EEG findings. Mossy fibre sprouting continues from one week to two months after injury. They usually begin with a focal aware seizure, then spread to a larger portion of the temporal lobe, resulting in impaired consciousness. Patients with mesial temporal sclerosis usually have an early brain insult, a febrile convulsion in most cases, and a seizure free interval of variable duration. This is more so on the left in verbal memory loss. Temporal lobe epilepsy is not the result of psychiatric illness or fragility of the personality. This is evident in intracellular recordings. [46][48][49], In the TLE brain, where granule cells are damaged or lost, axons, the mossy fibres, 'sprout' in order to reconnect to other granule cell dendrites. Regardless, an aura is actually a seizure itself, and such a focal seizure may or may not progress to a focal impaired awareness seizure. SPECT and PET imaging are also a useful adjuncts, with both ictal and interictal scans demonstrating abnormalities: Other causes of temporal lobe epilepsy (TLE) should be considered, especially as small temporal lobe cortical tumours can have similar appearances. These experiences are described (in possibly unreliable accounts) as complex interactions with their visions; but lack the stereotypy, amnestic periods, and automatisms or generalized motor events, which are characteristic of TLE. T2 relaxometry may also be useful in detecting cases of hippocampal sclerosis . [70], A study in 2015, reported that intrinsic religiosity and religiosity outside of organized religion were higher in patients with epilepsy than in controls. English: Mesial Temporal Sclerosis. Temporal lobe epilepsy (TLE) is a chronic disorder of the nervous system characterized by recurrent, unprovoked focal seizures that originate in the temporal lobe of the brain and last about one or two minutes. Our primary outcome is time-to-seizure recurrence. [3] Temporal lobe epilepsy (TLE) is the single most common form of focal seizure. [2] Focal seizures account for approximately sixty percent of all adult cases. Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is a group of chronic disorders characterized by prominent neuronal loss and gliosis in the hippocampus and amygdala. Up to a third of patients with established refractory temporal lobe epilepsy have a history of seizures in childhood at the time of fever . [12], Although the theory is controversial, there is a link between febrile seizures (seizures coinciding with episodes of fever in young children) and subsequent temporal lobe epilepsy, at least epidemiologically. Van Poppel K, Patay Z, Roberts D, Clarke DF, McGregor A, Perkins FF, Wheless JW J Child Neurol 2012 Jul;27(7):893-7. Rarely MTS can be detected in children during the first decade of life, but is not commonly found until adolescence. Most patients present with complex partial temporal lobe epilepsy. Clinical presentation. [26][27][28], Dispersion of the granule cell layer in the hippocampal dentate gyrus is occasionally seen in temporal lobe epilepsy and has been linked to the downregulation of reelin, a protein that normally keeps the layer compact by containing neuronal migration. Mesial temporal lobe epilepsy is the most common of the medically refractory chronic epilepsies. For patients with medial TLE whose seizures remain uncontrolled after trials of several types of anticonvulsants (that is, the epilepsy is intractable), surgical excision of the affected temporal lobe may be considered. Furthermore, in adults 3-10% of cases of mesial temporal sclerosis demonstrate bilateral changes even though symptoms may be unilateral. A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. Psychiatric conditions with psychotic spectrum symptoms might be more plausible physical explanation of these experiences. Mesial temporal sclerosis usually results in partial (focal) epilepsy. [64][65] Cognitive rehabilitation may also help. Together with other mesial temporal structures, the amygdala is important in the epilep … [citation needed], Seizures which begin in the temporal lobe, and then spread to involve both sides of the brain are termed focal to bilateral. [6] However, as of 2017 the general classification of seizures has been revised. 2. [31](p416–431)[46][50][51][52], Aberrant mossy fibre sprouting may create excitatory feedback circuits that lead to temporal lobe seizures. Ramachandran was able to show that patients with TLE showed enhanced emotional responses to the religious words, diminished responses to the sexually charged words, and normal responses to the neutral words. [29][30], In TLE, there is loss of neurons in region CA1 and CA3 of the hippocampus. In this patient it was a left sided temporal sclerosis. mesial temporal sclerosis: A condition characterised by induration of the middle temporal lobe, associated with cortical dysplasia and intractable temporal lobe epilepsy. [72], TLE has been suggested as a materialistic explanation for the revelatory experiences of prominent religious figures such as Abraham, Moses, Jesus, Mohammed, Saint Paul, Joan of Arc,[73] Saint Teresa of Ávila, and Joseph Smith. [38] According to the "dormant basket cell" hypothesis, mossy cells normally excite basket cells which in turn, inhibit granule cells. Most patients present with complex partial temporal lobe epilepsy. Vagal Nerve Stimulation is a minimally invasive mesial temporal sclerosis treatment that employs an implanted stimulator to deliver electric impulses to an electrode on the vagal nerve in the neck via a lead wire implanted under the skin. [citation needed] The postictal state in seizures other than focal aware may last much longer than the seizure itself. Clinical manifestations Pre-existing complex febrile convulsions are common. [74] They project into the hilus of the dentate gyrus and stratum lucidum in the CA3 region giving inputs to both excitatory and inhibitory neurons. Another treatment option is electrical stimulation of the brain through an implanted device called the vagus nerve stimulator (VNS). Mesial temporal sclerosis (MTS), also commonly referred to as hippocampal sclerosis, is the most common association with intractable temporal lobe epilepsy (TLE) 2,3,5. [1], Over forty types of epilepsy are recognized and these are divided into two main groups: focal seizures and generalized seizures. In TLE, the sprouting mossy fibres are larger than in the normal brain and their connections may be aberrant. This was noted in human tissue in 1974 and in animal models in 1985. The patient reported that God had sent him to the world to "bring redemption to the people of Israel". The diagnosis of temporal lobe epilepsy can include the following methods:[60] Magnetic resonance imaging (MRI), CT scans, positron emission tomography (PET), EEG, and magnetoencephalography. Mesial Temporal Sclerosis Mesial temporal sclerosis, also known as hip-pocampal sclerosis, is the most common cause of temporal lobe epilepsy found at surgery. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Mesial Temporal Sclerosis However, after temporal lobectomy, memory function is supported by the opposite temporal lobe; and recruitment of the frontal lobe. Dysphoric or euphoric feelings, fear, anger, and other emotions may also occur. (1998) Personality disorders. [39], In certain patients with temporal lobe epilepsy it has been found that the subiculum could generate epileptic activity. [20], Geschwind syndrome is a set of behavioural phenomena seen in some people with TLE. Automatic movements of the hands or mouth, Altered ability to respond to others, unusual speech, This page was last edited on 11 January 2021, at 00:42. Ramachandran presented two subjects with neutral, sexually arousing and religious words while measuring GSR. Mesial temporal sclerosis is a specific pattern of hippocampal neuron cell loss. PMID: 33113540. Mesial temporal sclerosis (MTS, also called hippocampal sclerosis) is the most common underlying cause of temporal lobe epilepsy (TLE). [11] People who experience only focal aware seizures may not recognize what they are, nor seek medical care. Conversely, due to neuronal dysfunction and swelling, diffusion is restricted following a seizure, and thus values are lower . TLE is the most common form of epilepsy with focal seizures. Follow up of children with febrile seizures does not demonstrate significant increased incidence of temporal lobe epilepsy . We evaluated the role of right and left hippocampal lesions on performance in both the retrospective and prospective PM components in patients with epilepsy secondary to mesial temporal sclerosis and correlated with performance in traditional neuropsychological tests, as well as with self-perception of memory impairment. [34] However, not all patients have granule cell dispersion. However, although the virus is found in temporal lobe tissue at surgery for TLE, it has not been recognised as a major factor in febrile seizures or TLE. [3] The seizures of LTLE are characterized by auditory or visual features. [43], Granule cell dispersion is a type of developmental migration and a pathological change found in the TLE brain which was first described in 1990. Temporal lobe in green, A sudden sense of unprovoked fear and anxiety, Auditory, visual, olfactory, gustatory, or tactile. Focal aware seizures often last less than sixty seconds; focal with impaired awareness seizures may last up to two minutes; and generalized tonic clonic seizures may last up to three minutes. The etiology is uncertain, although prolonged febrile seizures and limbic encephalitis have been implicated. Although the psychosocial impacts of epilepsy may be causative, there are also links in the phenomenology and neurobiology of TLE and depression. Histologi- [4], The International League Against Epilepsy (ILAE) recognizes two main types of temporal lobe epilepsy: mesial temporal lobe epilepsy (MTLE), arising in the hippocampus, the parahippocampal gyrus and the amygdala which are located in the inner (medial) aspect of the temporal lobe and lateral temporal lobe epilepsy (LTLE), the rarer type, arising in the neocortex at the outer (lateral) surface of the temporal lobe. Epub 2012 Apr 24 doi: 10.1177/0883073811435325. Associated hippocampal atrophy and gliosis is common. Most patients present with complex partial temporal lobe epilepsy. [54][55], However, aberrant mossy fiber sprouting may inhibit excitatory transmission by synapsing with basket cells which are inhibitory neurons and by releasing GABA and neuropeptide Y which are inhibitory neurotransmitters. This is an example of synaptic reorganization. [33][34][35][36][37] The loss of the GABA-mediated inhibitory interneurons may increase the hyperexcitability of neurons of the hippocampus leading to recurrent seizures. Pedley (Eds. When severe and long standing, additional associated findings include : Additional 3D volumetric studies can be performed, and although time consuming to post-process may be more sensitive to subtle hippocampal volume loss. Public domain Public domain false false: I, the copyright holder of this work, release this work into the public domain. Because a major function of the temporal lobe is short-term memory, a focal with impaired awareness seizure, and a focal to bilateral seizure can cause amnesia for the period of the seizure, meaning that the seizure may not be remembered. Etiology Hippocampal sclerosis. ), Benson, D.F. Where both sides of the brain or the whole brain are involved from the onset, these seizures are known as generalized seizures and may be tonic clonic. Study population An [21] The personality changes generally vary by hemisphere. MR spectroscopy findings typically represent neuronal dysfunction : MR perfusion demonstrates similar changes to SPECT (see below) with blood perfusion depending on when the scan is obtained. Histologically there is neuronal cell loss, gliosis and sclerosis. Vilayanur S. Ramachandran explored the neural basis of the hyperreligiosity seen in TLE using the galvanic skin response (GSR), which correlates with emotional arousal, to determine whether the hyperreligiosity seen in TLE was due to an overall heightened emotional state or was specific to religious stimuli. [31][32] There is also damage to mossy cells and inhibitory interneurons in the hilar region of the hippocampus (region IV) and to the granule cells of the dentate gyrus. Methods 2.1. Columbia Once Again Ranked Among Top Medical Schools and Hospitals by U.S. News & World Report Columbia Participates in Major NIH Stroke Prevention Trial Columbia Pediatric Neurosurgery Group Publishes Review of Sickle Cell Treatment Columbia Receives ‘Great Neurosurgery and Spine Program’ Recognition Columbia Resident Neurosurgeon, Dr. Benjamin Kennedy Sends us Greetings From Uganda! [21], The existence of a "temporal lobe epileptic personality" and of Geschwind syndrome have been disputed and research is inconclusive. Electrical Stimulation of Subiculum for the Treatment of Refractory Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis: A 2-Year Follow-Up Study. [citation needed], In TLE, the most commonly used older medications are phenytoin, carbamazepine, primidone, valproate, and phenobarbital. [14][15][16][17][18], After childhood onset, one third will "grow out" of TLE, finding a lasting remission up to an average of 20 years. This is the postictal state. This is followed by complex partial seizures with stereotypic semiology. [citation needed], Focal impaired awareness seizures are seizures which impair consciousness to some extent:[2] they alter the person's ability to interact normally with their environment. These were previously known as grand mal seizures. Felbamate and vigabatrin are newer, but can have serious adverse effects so they are not considered as first-line treatments. Olfactory hallucinations often seem indescribable to patients beyond "pleasant" or "unpleasant". Autosomal dominant lateral temporal lobe epilepsy (ADLTLE) is a rare hereditary condition, often associated with mutations in the LGI1 gene. The first line of treatment is through anticonvulsants. Simple focal seizures are the initial non-febrile seizures followed by [7] The arms, trunk, and legs stiffen (the tonic phase), in either a flexed or extended position, and then jerk (the clonic phase). [13], The temporal lobe and particularly the hippocampus play an important role in memory processing. [citation needed], Individuals with temporal lobe epilepsy have a higher prevalence of depression than the general population. [12] The word grand mal comes from the French term, meaning major affliction. study of patients with temporal lobe epilepsy of various age groups who underwent anterior temporal lobectomy and were diagnosed with mesial temporal sclerosis is needed to com-pare post-operative clinical outcomes between older and younger adults. [citation needed], Temporal lobe epilepsy is associated with memory disorders and loss of memory. [7] The newer classification uses three key features: where the seizures begin, the level of awareness during a seizure, and other features. TLE is diagnosed by taking a medical history, blood tests, and brain imaging. These impulses modulate the brain’s circuitry. It is seen in up to 65% of autopsy studies, although significantly less on imaging. Seizure 23/6 has published Factors predicting the outcome following medical treatment of mesial temporal epilepsy with hippocampal sclerosis. It can have a number of causes such as head injury, stroke, brain infections, structural lesions in the brain, or brain tumors, or it can be of unknown onset. For instance, if the dendrites of granule cells reconnect, it may be in a way (through the laminar planes) that allows hyperexcitability. The hippocampal formation is not uniformly affected, with the dentate gyrus, and the CA1, CA4 and to a lesser degree CA3 sections of the hippocampus being primarily involved . He found a constellation of symptoms that included hypergraphia, hyperreligiosity, collapse, and pedantism, now called Geschwind syndrome. (ed. It has been shown that it is theoretically possible to generate seizures in the neural networks due to down-regulation of KCC2,[41] consistent with the chloride measurements during the transition to seizure[42] and KCC2 blockade experiments. [1] A focal seizure in the temporal lobe may spread to other areas in the brain when it may become a focal to bilateral seizure. [75], In 2016, a case history found that a male temporal lobe epileptic patient experienced a vision of God following a temporal lobe seizure, while undergoing EEG monitoring. reduced hippocampal volume: hippocampal atrophy. 28-year-old male with a long-standing history of seizures localizing to the inferomedial right temporal lobe on EEG. In patients who are refractory to medical management temporal lobectomy or selective amygdalohippocampectomy may be performed. In 1981, the ILAE recognized three types of seizures occurring in temporal lobe epilepsy. [21], The causes of TLE include mesial temporal sclerosis, traumatic brain injury, brain infections, such as encephalitis and meningitis, hypoxic brain injury, stroke, cerebral tumours, and genetic syndromes. Neuronal loss on the right is more prominent in non-verbal (visuospatial memory loss). [44][45] The granule cells of the dentate gyrus are tightly packed forming a uniform, laminated layer with no monosynaptic connections. [19], The effect of temporal lobe epilepsy on personality is a historical observation dating to the 1800s. Diagnostic findings in mesial temporal sclerosis include interictal anterior temporal spikes on electroencephalography and hippocampal atrophy with increased T 2-weighted signal on magnetic resonance imaging .2, 3 Although mesial temporal sclerosis is generally unilateral, bilateral involvement is occasionally seen. Stereotact Funct Neurosurg. Vázquez-Barrón D, Cuéllar-Herrera M, Velasco F, Velasco AL. Loss of mossy cells lowers the threshold of action potentials of the granule cells. [63], Temporal lobe surgery can be complicated by decreased cognitive function. Mesial temporal lobe epilepsy (MTLE) associated with hippocampal sclerosis (HS) is considered an electroclinical syndrome, and there is a debate whether it is a unique disease or an entity with distinct subtypes. Age at onset Late childhood or adolescence. First-aid is only required if there has been an injury or if this is the first time a person has had a seizure. [62], Epilepsy surgery has been performed since the 1860s and doctors have observed that it is highly effective in producing freedom from seizures. In animal models, neuronal loss occurs during seizures but in humans, neuronal loss predates the first seizure and does not necessarily continue with seizure activity. Although comparing left to right side is easiest, it must be remembered that up to 10% of cases are bilateral, and thus if symmetry is the only feature being evaluated, many cases may be misinterpreted as normal. [66], Where surgery is not recommended, further management options include new (including experimental) anticonvulsants, and vagus nerve stimulation. It is not uncommon for an individual to be tired or confused for up to 15 minutes after a seizure has occurred, although postictal confusion can last for hours or even days. Learn more from the Epilepsy Foundation. We report on 2 male patients aged 4 years with suspected TLE due to MTS who were referred for presurgical evaluation. Mesial temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated with certain brain injuries. The finding of a lesion such as hippocampal sclerosis (a scar in the hippocampus), tumour, or dysplasia, on magnetic resonance imaging (MRI) predicts the intractability of seizures. Coronal volume and coronal high resolution T2WI/FLAIR are best to diagnose MTS. PMID: 22532537. There are 3 specific patterns of cell loss; Cell loss might involve sectors CA1 and CA4, CA4 alone, or CA1 to CA4 . Surgery may be an option, especially when there is an observable abnormality in the brain. It has been suggested that Pope Pius IX's doctrine of the immaculate conception was influenced by his forensically-diagnosed partial epilepsy. Other medical conditions with similar symptoms include panic attacks, psychosis spectrum disorders, tardive dyskinesia, and occipital lobe epilepsy. & Hermann, B.P. mesial temporal sclerosis, the types of imaging tech-niques used to diagnosis this entity, and the possible significance of secondary MR findings. Prevalence ~20% of patients with epilepsies; 65% of mesial TLE. TLE is initially managed medically with anti-epileptic agents. Mesial temporal sclerosis Etiology Controversy exists as to the causative mechanism: is mesial temporal sclerosis a result of temporal lobe epilepsy or viceversa. PATHOPHYSIOLOGY • Mesial temporal sclerosis -coined by Falconer & colleagues – by neuronal loss and gliosis involving principally the hippocampus and amygdala, or both, but occasionally extending to other mesial temporal structures or even throughout the temporal lobe, and leading to generalized atrophy and gliosis. Up to a third of patients with established refractory temporal lobe epilepsy have a history of seizures in childhood at the time of fever 3. If anything, care must be taken not to allow an enlarged horn to trick you into thinking the hippocampus is reduced in size. [7], Focal seizures in the temporal lobe involve small areas of the lobe such as the amygdala and hippocampus. [31](p387–389), Mossy fibers are the axons of granule cells. Mesial temporal sclerosis is the loss of neurons and scarring of the deepest portion of the temporal lobe and is associated with certain brain injuries. For example, if a person with complex partial seizures is driving alone, this can cause them to run into the ditch, or worse, cause an accident involving multiple people. See all (206) The condition called mesial temporal sclerosis is closely related to temporal lobe epilepsy, a type of partial (focal) epilepsy in which the seizure initiation point can be identified within the temporal lobe of the brain. 2020 Oct 28:1-8. doi: 10.1159/000510295. Follow up of children with febrile seizures does not demonstrate signifi… Newer drugs, such as gabapentin, topiramate, levetiracetam, lamotrigine, pregabalin, tiagabine, lacosamide, and zonisamide promise similar effectiveness, with possibly fewer side-effects. The degree and length of postictal impairment directly correlates with the severity of the seizure type. In interictal periods, conversely, perfusion is reduced . Focal aware means that the level of consciousness is not altered during the seizure. Mesial temporal sclerosis is a frequent cause of epilepsy. This applies worldwide. Aetiology Major cerebral trauma, infection, febrile illness in childhood; most patients are seizure-free after ablative surgery. [71] Lower education level, abnormal background EEG activity, and hippocampal sclerosis have been found to be contributing factors for religiosity in TLE. Others have questioned the evidence for a link between temporal lobe epilepsy and religiosity. ), "A proposed diagnostic scheme for people with epileptic seizures and with epilepsy: report of the ILAE Task Force on Classification and Terminology", "LGI1 mutations in autosomal dominant and sporadic lateral temporal epilepsy", "2017 Revised Classification of Seizures", "Synesthetic associations and psychosensory symptoms of temporal epilepsy", "Cortical thickness abnormalities associated with depressive symptoms in temporal lobe epilepsy", "Association of Human Herpesvirus-6B with Mesial Temporal Lobe Epilepsy", "Detection of human herpesvirus-6 in mesial temporal lobe epilepsy surgical brain resections", "Role for reelin in the development of granule cell dispersion in temporal lobe epilepsy", "Reelin deficiency and displacement of mature neurons, but not neurogenesis, underlie the formation of granule cell dispersion in the epileptic hippocampus", "Loss of hilar mossy cells in Ammon's horn sclerosis", "Reduced inhibition of dentate granule cells in a model of temporal lobe epilepsy", "Quantitative post-mortem study of the hippocampus in chronic epilepsy: seizures do not inevitably cause neuronal loss", "GABAergic mechanisms in the pathogenesis and treatment of epilepsy", "Perturbed Chloride Homeostasis and GABAergic Signaling in Human Temporal Lobe Epilepsy", "Reduced Efficacy of the KCC2 Cotransporter Promotes Epileptic Oscillations in a Subiculum Network Model", "Pyramidal cells accumulate chloride at seizure onset", "Selective Inhibition of KCC2 Leads to Hyperexcitability and Epileptiform Discharges in Hippocampal Slices and In Vivo", "Cell proliferation and granule cell dispersion in human hippocampal sclerosis", 10.1002/(sici)1096-9861(19970901)385:3<325::aid-cne1>3.0.co;2-5, "Axon sprouting in a model of temporal lobe epilepsy creates a predominantly excitatory feedback circuit", "Evidence of functional mossy fiber sprouting in hippocampal formation of kainic acid-treated rats", "Kainic acid-induced recurrent mossy fiber innervation of dentate gyrus inhibitory interneurons: possible anatomical substrate of granule cell hyperinhibition in chronically epileptic rats", "Spontaneous release of neuropeptide Y tonically inhibits recurrent mossy fiber synaptic transmission in epileptic brain", "Temporal Lobe Epilepsy Workup: Approach Considerations, Computed Tomography Scanning, Magnetic Resonance Imaging", "Temporal Lobe Epilepsy; TLE medical Information Page | Patient", "Changing frontal contributions to memory before and after medial temporal lobectomy", "MR-guided stereotactic laser ablation of epileptogenic foci in children", "Spirituality aspects in patients with epilepsy", "The role of psychotic disorders in religious history considered", "Seizures among public figures: lessons learned from the epilepsy of Pope Pius IX", Reproductive endocrinology and infertility, Bachelor of Medicine, Bachelor of Surgery, https://en.wikipedia.org/w/index.php?title=Temporal_lobe_epilepsy&oldid=999598843, Short description is different from Wikidata, Articles with unsourced statements from December 2020, Articles with unsourced statements from September 2016, Articles with unsourced statements from February 2014, Articles needing additional medical references from August 2017, All articles needing additional references, Articles requiring reliable medical sources, Creative Commons Attribution-ShareAlike License, Lobes of the brain. 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