Hippocampal Sclerosis

Question 1

Etiology of hippocampus

Answer 1

Unclear but suspect vascular insult or infection that can damage the hippocampus

Febrile seizures and status epilepticus during the first year of life are the most common antecedent. The cortex and hippocampal areas might be more susceptible to damage but younger than 6 months seem to be more protected

Some say pre-existing

Question 2

Incidence of febrile seizures

Answer 2

7%

Question 3

Percentage of adult patients with HS who had previous history of FS

Answer 3

10-40%

Question 4

Prevalence of epilepsy after febrile seizures

Answer 4

1% after simple febrile seizures compared to 22% following complex febrile seizures where seizures are unilateral or prolonged

Question 5

Percentage of patients with history of status epilepticus who are found to develop hippocampal sclerosis

Answer 5

40%

Question 6

When is seizure freedoms unlikely

Answer 6

When fail 2 AEDs not likely to achieve seizure freedom

Patients with HS are likely to be intractable in about 90% of cases - surgery is the treatment of choice

Question 7

Risks that cause worse outcomes

Answer 7

Earlier age at onset of epilepsy has been related to most severe grade of HS and poorer post surgical outcome

Question 8

Most predictive indicator for controlled seizures after surgery

Answer 8

Positive MRI for hippocampal atrophy predicts seizure control following temporal lobectomy in more than 90% of patients