Medial temporal lobe epilepsy associated with cortical dysplasia extending from the medial temporal lobe to the fornix: a case report

We report a case of lesional medial temporal lobe epilepsy (TLE) associated with cortical dysplasia extending from the right medial temporal lobe to the fornix via the basal and medial aspects of the frontal lobe and septum pellucidum. A 23-year-old man had had medically intractable psychomotor seizures since 11 years of age. Interictal EEG demonstrated paroxysmal activities in the right temporal region, and functional imaging by positron emission tomography with [18F] fluorodeoxyglucose revealed a functional deficit zone in the apex and medial part of the right temporal lobe. An intraoperative electrocorticogram demonstrated frequent paroxysmal activities in the medial temporal lobe. An anterior temporal lobectomy was performed, with an additional hippocampectomy including the focus of the paroxysmal activities on the intraoperative hippocampal EEG. Postoperatively, he became seizure-free. The surgical strategies for intractable TLE with widely distributed cortical dysplasia lesion are discussed.