Relationship of hippocampal sclerosis to duration and age of onset of epilepsy, and childhood febrile seizures in temporal lobectomy patients

Davies, Keith G.; Hermann, Bruce P.; Dohan, F.Curtis; Foley, Kevin T.; Bush, Andrew J.; Wyler, Allen R.

Next »Epilepsy Research
Volume 24, Issue 2 , Pages 119-126, June 1996

Relationship of hippocampal sclerosis to duration and age of onset of epilepsy, and childhood febrile seizures in temporal lobectomy patients

Keith G. Davies
- Corresponding author. 930 Madison Avenue, Suite 700, Memphis, TN 38103, USA. Tel.: +1 (901) 522 2660; fax: +1 (901) 522 2665.
- Epi-Care Center, Baptist Memorial Hospital, Memphis, TN, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
- Department of Psychiatry, University of Tennessee, Memphis, TN, USA
Bruce P. Hermann
- Epi-Care Center, Baptist Memorial Hospital, Memphis, TN, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
- Department of Psychiatry, University of Tennessee, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee, Memphis, TN, USA
F.Curtis Dohan Jr.
- Department of Pathology, University of Tennessee, Memphis, TN, USA
Kevin T. Foley
- Epi-Care Center, Baptist Memorial Hospital, Memphis, TN, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
- Department of Psychiatry, University of Tennessee, Memphis, TN, USA
Andrew J. Bush
- Department of Preventive Medicine, University of Tennessee, Memphis, TN, USA
Allen R. Wyler
- Epilepsy Center, Swedish Medical Center, Seattle, WA, USA

Received 20 June 1995; received in revised form 15 December 1995; accepted 8 January 1996.

Abstract

Controversy exists as to whether hippocampal sclerosis (HS) is a preexisting cause or a consequence of seizures. We investigated 122 consecutive patients who underwent anterior temporal lobectomy for intractable epilepsy between 1989 and 1992. MRI scans were normal apart from evidence of HS in 5 cases. The degree of HS was graded from 0 to 4. There was a significant inverse correlation between age of seizure onset and grade of HS (P < 0.0001), and a positive correlation between duration of epilepsy and grade of HS (P < 0.001). Using a dichotomous grouping of HS (HPSC − for grades 0 and 1 [no/mild HS], and HPSC + for grades 3 and 4 [moderate/marked HS]), there was a positive correlation between HPSC + and a history of childhood febrile seizures (CFS) (P = 0.003), earlier age of onset of epilepsy (P < 0.001) and longer duration epilepsy (P < 0.001). There was no correlation with history of particularly prolonged individual seizures. Partial correlations after controlling for age at onset of epilepsy showed that there was no longer a significant relationship between HPSC + and duration of epilepsy. After controlling for duration of epilepsy, the relationship between HPSC + and age of onset remained significant (P < 0.001). The correlation between HPSC + and CFS, controlling for age at onset, was not significant. A series of logistic regression analyses showed age at onset to be the only predictor of HPSC +. It is concluded that this is supportive evidence for preexisting HS being a cause of temporal lobe epilepsy and not a consequence of seizures

Keywords: Epilepsy, Febrile seizure, Hippocampal sclerosis, Temporal lobectomy

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