Oncogenic Pathways Provide Clue to the Etiology of Human Mesial Temporal Lobe Epilepsy

Consider this clinical scenario: A right-handed previously healthy male in his late 20s presents with a 15-year history of focal impaired awareness seizures manifesting at onset with an aura of rising gastric sensation followed by impaired awareness, unresponsiveness, repetitive chewing, and left-hand automatisms of picking at his clothes. After a seizure, he is confused and tired. His events occur weekly and typically in a cluster despite a combination therapy with 3 antiseizure medications. Recent 3-T brain imaging showed signal changes consistent with hippocampal sclerosis, and a 24-hour ambulatory electroencephalography showed focal slow activity and sleep-activated epileptiform sharp waves in the left anterior temporal region as well as one electrographic seizure in this area. Aside from the lesional magnetic resonance imaging finding, the patient has no identifiable risk factors for epilepsy, comprehensive review of systems is negative, and neurological examination findings are normal.
Source: JAMA Neurology - Category: Neurology Source Type: research