Dominant, Mesial Temporal Lobe Epilepsy Due to Hippocampal Sclerosis

This chapter describes a patient who underwent MRI-guided thermoablative therapy for dominant mesial temporal lobe pharmacoresistant epilepsy due to hippocampal sclerosis. The objective of this chapter is to discuss the safety, efficacy, and tolerability of MRI-guided laser interstitial thermoablative therapy in patients with mesial temporal lobe epilepsy secondary to hippocampal sclerosis. We discuss the technical aspects of this therapy, as well as predictors of a favorable post-ablation seizure outcome, neuropsychological outcome, and potential complications, such as visual field defects. We also briefly review the data regarding deep brain stimulation of the hippocampus in patients with mesial temporal lobe epilepsy. We provide a brief overview of the association between febrile seizure and hippocampal sclerosis. We analyze semiologies such as gustatory and olfactory hallucinations, palilalia, and sniffing gestures in greater detail.