%0 Journal Article
%T The ˇ°Naturalˇ± History of Medically Treated Temporal Lobe Epilepsy: What Can an Evidence-Based Approach Tell Us?
%A Colin Bruce Josephson
%A Bernhard Pohlmann-Eden
%J Epilepsy Research and Treatment
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/216510
%X We systematically reviewed the literature to describe the ˇ°naturalˇ± history of medically treated temporal lobe epilepsy (TLE). No population-based studies recruiting incident cases of TLE irrespective of age exist. Prospective, population-based studies were limited to those recruiting only childhood-onset TLE or those reporting TLE as a subgroup of cohorts of focal epilepsies. Few studies have been performed in the ˇ°MRI eraˇ± limiting information on natural history secondary to specific pathologies. Available data suggests that TLE is highly variable, with unpredictable transient remissions and low rates of seizure freedom (30 to 50%). Etiology and failure of first and second drug seem to be the most important predictors for treatment prognosis. The role of initial precipitating injuries remains speculative, as imaging information of related events is either missing or conflicting. Prospective cohorts of new-onset TLE with long-term followup using advanced MRI techniques, timely EEG recordings, and assessments of psychiatric comorbidities are needed. 1. Introduction Temporal lobe epilepsy (TLE) is the most frequent medically refractory epilepsy syndrome seen in epilepsy outpatient clinics. It has received considerable attention in recent years owing to the remarkable rates of remission that can be achieved through surgical intervention [1]. Mesial temporal lobe epilepsy (mTLE) associated with hippocampal sclerosis (mTLE-HS), a condition that can be detected by modern magnetic resonance imaging (MRI) techniques with a high sensitivity and specificity, is now the most common indication for epilepsy surgery. To date, therapeutic advances in TLE have far outpaced our understanding of the natural history of the disorder. According to a recent International League Against Epilepsy (ILAE) commission report [2], the natural history of mTLE-HS is characterized by key features such as a history of an initial precipitating injury and a presence of a latent and/or silent period. Prior publications have attempted to assess the course and prognosis of TLE, mTLE, and mTLE-HS using sophisticated electroencephalography (EEG), MRI, and histological techniques trying to identify the ˇ°naturalˇ± history of all types of TLE. Almost all these studies are limited by the fact that their perspective comes from tertiary care centers and surgical series [3]. The ideal natural history study requires a large prospective cohort of patients with new-onset TLE undergoing extensive structural and functional testing with a followup of >10 years. We conducted a systematic review of the
%U http://www.hindawi.com/journals/ert/2012/216510/