MurrayA. Falconer

MESIAL TEMPORAL (AMMON'S HORN) SCLEROSIS AS A COMMON CAUSE OF EPILEPSY: ETIOLOGY, TREATMENT, AND PREVENTION

Abstract Mesial temporal (Ammons horn) sclerosis is the most common single lesion to be found post mortem in the brains of chronic epileptics who die a natural death. Its significance has long been a matter of dispute. Evidence shows that it usually arises in infancy, often as a result of a prolonged febrile convulsion, and that it then becomes a potent epileptogenic lesion. It is usually unilateral. The results of operation for epilepsy are often excellent whenever this lesion is found in the resected specimen. It can be produced experimentally in adolescent baboons by inducing serial epileptic attacks or status epilepticus. Paediatricians in Copenhagen have shown that, by timely treatment of severe febrile convulsions in infants followed by prophylactic therapy with phenobarbitone, later habitual epilepsy can be avoided. Thus both Ammons horn sclerosis and its consequent epilepsy are probably preventable.

OUTCOME OF SURGERY IN 40 CHILDREN WITH TEMPORAL-LOBE EPILEPSY

Temporal-lobe epilepsy commonly has its origins in childhood, particularly when the lesion involved is mesial temporal (Ammons horn) Sclerosis. Evidence suggests that this lesion is probably a common cause of chronic epilepsy in adults and that often it is probably the result of a severe febrile convulsion in infancy. 40 children, fifteen years of age and younger, who had an anterior temporal lobectomy were followed up for one to twenty-four years. The findings confirm those already established in adults, that the best results of surgery, not only in seizure relief but also in behaviour, are obtained when mesial temporal sclerosis is the lesion found at operation, and also indicate that a severe febrile convulsion in infancy is often the chief provocative factor in the development of epilepsy.