The patient, WL, experienced febrile seizures as a child and was later diagnosed with left mesial temporal lobe epilepsy (MTLE) based on EEG, MRI, and other testing. An MRI showed hippocampal sclerosis on the left side. Pre-surgery memory and language tests (Wada test) indicated memory dominance in both hemispheres but greater role for the left temporal lobe and hippocampus. WL underwent a left amygdalohippocampectomy and anterior temporal lobectomy, with no further seizures and no clear memory problems post-surgery.

1. Mesial Temporal Lobe Epilepsy
The motivation to select the subject to epilepsy is that I had an experience of assisting
epilepsy research in a hospital on patients who underwent epilepsy surgery. In this
project I investigated about an epilepsy patient’s case and correlated with the
knowledges learnt through this course.
Epilepsy
Epilepsy is a group of long-term neurological disorders characterized by epileptic
seizures. These seizures are episodes that can vary from brief and nearly undetectable
to long periods of vigorous shaking. The causes of epilepsy is mostly the result of brain
injury, stroke, brain cancer, and drug and alcohol misuse, among others. Epileptic
seizures are the result of excessive and abnormal cortical nerve cell activity in the brain.
Mesial temporal lobe epilepsy(MTLE) is the most common type among epilepsy, and 40
to 67% of MTLE are known to have febrile seizures in their early ages.
Patient Case
The patient I studied has been diagnosed as Left MTLE. The patient’s detail is as
follows:
● Name: WL
● Age: 22
● Sex: M
● Past Medical History: Febrile seizure when 2 years old
● EEG findings: Ictal onset on left temporal area
● Semiology: Chewing and lip smacking, right arm posturing
● Brain MRI: Left hippocampal sclerosis (Figure 1)
● SPECT, SISCOM, PET: Left anterior basal, mesial temporal significance
● Hippocampal volumetry: Right: 3068.4 ㎣, Left: 1615.6 →㎣ difference(Rt-Lt):
1452.8 ㎣

2. Figure 1
Interpretation
According to the brain MRI, WL has a lesion on his left hippocampus, a limbic system in
anatomical point of view, neuroimaging evaluations also shows signal changes from
mesial temporal area and left hippocampal volumetry reduction, all of those are parts of
telencephalon.
In semiology, chewing and lip smacking has shown in his every starting moment of
seizures and those behaviors could be regarded as being controlled by Central Pattern
Generator,as it happened without the patient’s intention. His stereotyped behavior is
also called as automatism which is common symptom in MTLE.
When seizure begins, he has shown right arm posturing, which is controlled by left
motor cortex and also involved by right cerebellum.
Memory Test
Epilepsy cannot be cured, but seizures are controllable with medication in about 70% of
cases. In those whose seizures do not respond to medication, surgery, neurostimulation
or dietary changes may be considered.

3. WL’s case was intractable partial epilepsy so he decided to take a surgery.
But hippocampus is doing a crucial role in memory function. As we have learned from
the case of HM, HM got dense amnesia after bilateral hippocampal resection.
Declarative memories(both semantic and episodic) first go to hippocampus and then
reconsolidated in neocortex. This means that without hippocampus, a person cannot
remember about any new information or events.
So before his hippocampus and some part of temporal lobe are resected, he had to
take presurgical test to check memory and language dominance area, which is called
Wada test.
Wada test is used to determine localization, that is which functions are located in which
part of the brain. The test consists of administering a drug, sodium amytal, to the
internal carotid artery one hemisphere at a time, thereby inducing a temporary lesion
lasting only a few minutes.
Before injecting the drug, the patient is given tests measuring his or her abilities in
speech, object naming, and memory. While one hemisphere is anesthetized, the
neuropsychologist then tests the other hemisphere to evaluate how well it manages
speech, naming, and memory.(Figure 2)

4. Figure 2

5. Table 1
In WL’s result(Table 1), he had aphasia when drug injected and underwent to the left
hemisphere anesthesia. That means WL has language center on the left hemisphere
and the Broca’s area did not function well. The red box shows only left hemisphere
awakened, percentage of successful memory function is higher than that of right
hemisphere awakened even right hemisphere's function is also above 50%. So WL’s
memory dominance is bilateral but left temporal lobe and hippocampus has greater role
in mediating memory.
Surgery Outcome
Based on the presurgical investigations above, surgeons operated left
amygdalohippocampectomy with left anterior temporal lobectomy. Post surgery follow
up result shows that he has no seizure and no clear memory function problem. This
means that the presurgical evaluations are properly conducted and interpreted.
Influence of this Course
Through this course I realized how important it is to sustain neural developing during

6. childhood. Any accidental impact ( febrile seizures, viruses, physical attacks, trauma) on
neural network or brain can cause severe disease in someone’s adulthood which
influences on quality of life.
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Reference
http://radiopaedia.org/encyclopaedia/quizzes/all/9007/studies/9766
http://en.wikipedia.org/wiki/Epilepsy
http://www.cse.buffalo.edu/~rapaport/575/memory.html
http://www.3icreative.com/psych/forebrain-telencephalon-diencephalon.html

7. childhood. Any accidental impact ( febrile seizures, viruses, physical attacks, trauma) on
neural network or brain can cause severe disease in someone’s adulthood which
influences on quality of life.
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-----
Reference
http://radiopaedia.org/encyclopaedia/quizzes/all/9007/studies/9766
http://en.wikipedia.org/wiki/Epilepsy
http://www.cse.buffalo.edu/~rapaport/575/memory.html
http://www.3icreative.com/psych/forebrain-telencephalon-diencephalon.html