Department of Neurology

Mesial sclerosis of the temporal lobe and surgery

Q: My ten year old was diagnosed with Temporal Mesial Sclerosis two years ago after having a status epilepticus seizure for the first time. She has not had any seizures since and is on anti-convulsant medication. Her MRI results and EEG show a slowing in the brain near the hippocampus and she does have lesions as well as gliosis. In July of last year she had her last MRI and has not been seen by the doctor since before her MRI. Last week I contacted the doctor to have a form filled out for her to go to camp with the school. The doctor asked how she was and I explained she was fine and without seizure and he advised that she needed to go to a neurosurgeon as soon as possible. I was very shocked and failed to ask all of the right questions. I am wondering why she would be required to see a surgeon and also why a doctor would wait from July of last year until now to send her to a surgeon.

Please advise. I would also like to find out more information on Gliosis. The only thing I know is that it is proliferation of cells in the central nervous system.

Thank you in advance for your prompt response.


A: Mesial sclerosis is probably the most common cause of epilepsy in persons with temporal lobe epilepsy. Doctors often explain it as "scarring" to their patients, althought it is not the same sort of thing you would get from a cut on the knee. What is seen is loss of brain nerve cells in a structure called the hippocampus, and increases in the brain cells that make up the support structure (glial cells, hence the term gliosis).

Epilepsy surgery is usually reserved for patients who do not respond to medicines. While it is not possible for us to evaluate your daughter with the information you have provided, it does not sound like she fits this category.

On the other hand, your doctor may have found some other problem that he wants the neurosurgeon to evaluate. You should clarify this with you doctor.

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