Dominant, Lesional Mesial Temporal Lobe Epilepsy

This chapter discusses the classical presentation and course of mesial temporal lobe epilepsy due to hippocampal sclerosis. We review its neuroimaging and EEG findings, possible pathophysiology, histopathology, and surgical outcomes. We present a detailed description of Spencer’s method for anteromedial temporal lobectomy. We also analyze semiologies such as ictal fear and its differentiation from panic attacks, ictal olfactory hallucinations, manual automatisms, ictal dystonia, limb akinesia, and ictal amnesia. Lastly, we briefly discuss the “start-stop-start” pattern seen in temporal lobe seizures.