Is Ictal Recording Mandatory in Temporal Lobe Epilepsy?

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Abstract
HIGH-RESOLUTION magnetic resonance imaging (MRI) has had a major impact on the evaluation of patients with refractory epilepsy, because MRI can detect many underlying lesions that previously could not be identified in vivo. The most common example of this is mesial temporal atrophy associated with neuronal loss and gliosis on histopathologic examination, a condition known as mesial temporal sclerosis or hippocampal sclerosis.1,2 The demonstration by MRI of obvious atrophy or altered signal intensity of mesial temporal structures suggestive of mesial temporal sclerosis has greatly streamlined the presurgical evaluation of patients with temporal lobe epilepsy (TLE) in whom these abnormalities are present.3-8 However, there are still uncertainties about the predictive value of hippocampal atrophy for electroencephalogram (EEG) lateralization and how often discrepancies between MRI and EEG are to be expected in the evaluation of patients with TLE.