Uncovering a Commonly Missed Cause of Drug-Resistant Epilepsy: A Case Report on Surgical Intervention for Hippocampal Sclerosis

Abstract

Rationale: 

This study aimed to present a case of drug-resistant epilepsy caused by hippocampal sclerosis (HS). Furthermore, this study highlights the critical role of standardized and precise surgical intervention in the management of drug-resistant epilepsy (DRE), thereby providing a valuable reference for similar cases.

Patient concerns: 

A 19-year-old male was admitted with frequent generalized tonic-clonic seizures. Imaging studies revealed characteristic features of left-sided HS, including symmetric bilateral hippocampi on hippocampal thin-slice magnetic resonance imaging, reduced volume of the left hippocampus, signal hyperintensity on T2-FLAIR imaging, and enlargement of the adjacent temporal horn of the lateral ventricle. 

Diagnoses: 

The diagnosis of DRE was made.

Interventions: 

The standard left anterior temporal lobectomy (ATL) was performed with the assistance of neuronavigation and intraoperative electrophysiological monitoring.

Outcomes: 

The patient underwent a standard left ATL. Postoperative pathology confirmed that the resected HS tissue was brain tissue, with no evidence of tumor lesions. The patient showed significant improvement in symptoms postoperatively, with no complications, and was discharged smoothly. Follow-up at 2 months, including 2 electroencephalograms, showed no typical abnormal wave activity during both awake and sleep states, with no clinical seizures. 

Lessons: 

Hippocampal sclerosis-related DRE are prone to misdiagnosis. It is recommended that hippocampal thin-slice Magnetic Resonance Imaging (MRI) should be routinely performed for DRE. Neuronavigation and intraoperative electrophysiological monitoring play crucial roles in the implementation of standard ALT. The epilepsy surgery team should provide continuous postoperative rehabilitation counseling and support for the patient and family.