Temporal Lobe Epilepsy: From Etiology to Treatment

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Fernando Cendes

State University of Campinas

Esper A. Cavalheiro

Federal University of São Paulo

Luis Concha

National Autonomous University of Mexico

Boris Bernhardt

Montreal Neurological Institute, McGill University Health Centre

Antonio Gambardella

Institute of Neurology, Department of Medical and Surgical Sciences, University of Magna Graecia

Angelo Labate

Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina

Paolo Federico

University of Calgary

Samuel Wiebe

University of Calgary

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Temporal lobe epilepsy (TLE) represents the most common focal epilepsy syndrome in adulthood. In tertiary referral centers, many of these patients are eventually evaluated because of pharmacoresistance and therefore represent potential candidates for epilepsy surgery or other precise therapeutic approaches. Among the different etiologies, hippocampal sclerosis in adults and focal cortical dysplasia in children are the most common pathologies identified on magnetic resonance imaging (MRI), and have advanced and accurate diagnostic and therapeutic approaches. However, in around 20-30% of refractory patients with TLE, brain MRI does not demonstrate any epileptogenic lesion. The etiologies behind this “non-lesional” TLE is being clarified by the identification of new pathologies that do not leave a specific trace in brain MRI, or in which this trace is difficult to identify. Difficult to diagnose etiologies in TLE include some forms of autoimmune epilepsies, TLE with a genetic origin, and “occult” temporal pole encephaloceles, that might be considered both in controlled and refractory “non-lesional” TLE. While significant advances have been made in the diagnosis and treatment of hippocampal sclerosis and cortical dysplasia, diagnosis of other etiologies is challenging, ultimately resulting in held or delayed therapies and worse outcomes.

This Research Topic focuses on reviewing stablished approaches and novel advances in the translational and clinical research on the etiology, diagnosis and therapy of different causes of TLE. In the last decade, the field of focal epilepsy, and particularly of TLE, has experience huge advances that involve not only the characterization of underrecognized or new pathologies but also in the implementation of novel diagnostic modalities that better characterize TLE as a network disease with multiple causes and diverse therapeutic approaches. The goals of this review series are: (1) to characterize novel, difficult to recognize types and etiologies, such as temporal plus syndromes, temporal encephalocele, autoimmune epilepsy and genetic TLE; (2) to establish the different patterns of cognitive and psychiatric involvement in TLE and the progressive nature of cognitive decline in some cases; (3) to provide an update on neurophysiological advances in the diagnosis of different forms of TLE, such as electric/magnetic source analysis and electroencephalographic patterns; (4) to discuss the different surgical approaches, with special attention to precision techniques such as stereotactic laser ablation and stereoelectroencephalography-guided radiofrequency thermocoagulation; (5) to outline non-surgical therapeutic approaches, such as immune-modulation and new anti-seizure medication, and (6) experimental research about epileptogenesis in TLE models.

Therefore, we welcome studies in the form of Original Research articles, Reviews, Brief Research Reports and Case Reports related to the following topics:

1. Characterization of novel or unrecognized pathologies

2. Distinguishing semiology in TLE that help define the epileptogenic zone

3. Cognition and comorbidities in patients with TLE

4. Advanced neurophysiological methods

5. Novel neuroimaging modalities and their application in clinical grounds

6. Non-surgical treatment of TLE

7. Advances in epilepsy surgery with a special emphasis in minimally invasive surgical approaches and neuromodulation

8. Comprehensive reviews and original papers on experimental research in TLE models.

Temporal lobe epilepsy (TLE) represents the most common focal epilepsy syndrome in adulthood. In tertiary referral centers, many of these patients are eventually evaluated because of pharmacoresistance and therefore represent potential candidates for epilepsy surgery or other precise therapeutic approaches. Among the different etiologies, hippocampal sclerosis in adults and focal cortical dysplasia in children are the most common pathologies identified on magnetic resonance imaging (MRI), and have advanced and accurate diagnostic and therapeutic approaches. However, in around 20-30% of refractory patients with TLE, brain MRI does not demonstrate any epileptogenic lesion. The etiologies behind this “non-lesional” TLE is being clarified by the identification of new pathologies that do not leave a specific trace in brain MRI, or in which this trace is difficult to identify. Difficult to diagnose etiologies in TLE include some forms of autoimmune epilepsies, TLE with a genetic origin, and “occult” temporal pole encephaloceles, that might be considered both in controlled and refractory “non-lesional” TLE. While significant advances have been made in the diagnosis and treatment of hippocampal sclerosis and cortical dysplasia, diagnosis of other etiologies is challenging, ultimately resulting in held or delayed therapies and worse outcomes.

This Research Topic focuses on reviewing stablished approaches and novel advances in the translational and clinical research on the etiology, diagnosis and therapy of different causes of TLE. In the last decade, the field of focal epilepsy, and particularly of TLE, has experience huge advances that involve not only the characterization of underrecognized or new pathologies but also in the implementation of novel diagnostic modalities that better characterize TLE as a network disease with multiple causes and diverse therapeutic approaches. The goals of this review series are: (1) to characterize novel, difficult to recognize types and etiologies, such as temporal plus syndromes, temporal encephalocele, autoimmune epilepsy and genetic TLE; (2) to establish the different patterns of cognitive and psychiatric involvement in TLE and the progressive nature of cognitive decline in some cases; (3) to provide an update on neurophysiological advances in the diagnosis of different forms of TLE, such as electric/magnetic source analysis and electroencephalographic patterns; (4) to discuss the different surgical approaches, with special attention to precision techniques such as stereotactic laser ablation and stereoelectroencephalography-guided radiofrequency thermocoagulation; (5) to outline non-surgical therapeutic approaches, such as immune-modulation and new anti-seizure medication, and (6) experimental research about epileptogenesis in TLE models.

Therefore, we welcome studies in the form of Original Research articles, Reviews, Brief Research Reports and Case Reports related to the following topics:

1. Characterization of novel or unrecognized pathologies

2. Distinguishing semiology in TLE that help define the epileptogenic zone

3. Cognition and comorbidities in patients with TLE

4. Advanced neurophysiological methods

5. Novel neuroimaging modalities and their application in clinical grounds

6. Non-surgical treatment of TLE

7. Advances in epilepsy surgery with a special emphasis in minimally invasive surgical approaches and neuromodulation

8. Comprehensive reviews and original papers on experimental research in TLE models.

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Editors

Fernando Cendes

State University of Campinas

Esper A. Cavalheiro

Federal University of São Paulo

Luis Concha

National Autonomous University of Mexico

Boris Bernhardt

Montreal Neurological Institute, McGill University Health Centre

Antonio Gambardella

Institute of Neurology, Department of Medical and Surgical Sciences, University of Magna Graecia

Angelo Labate

Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina

Paolo Federico

University of Calgary

Samuel Wiebe

University of Calgary

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Published In

Frontiers in Neurology

Epilepsy

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