MRI影像改变对颞叶癫痫术后疗效的影响

目的 研究颞叶癫痫(TLE)患者的MRI影像与病理结果 的相关性,分析不同MRI改变对术后疗效的影响.方法 回顾2005年1月至2008年12月在我科手术治疗且有效随访的121例TLE患者的临床资料,统计分析MRI影像改变与病理结果 的关系;根据MRI影像改变将患者分为内侧型TLE、有结构性改变的TLE和隐源性TLE,利用Engel分级将患者分为无发作组和发作组,比较不同类型TLE患者术后疗效的差异.结果 121例患者中MRI结果 阳性101例,病理结果 阳性107例,二者差异无统计学意义,具有良好的相关性.隐源性TLE患者的术后疗效较内侧型TLE和有结构性病变的TLE差,而后二者之间差异无统计学意义.结论 MRI检查对于TLE的确诊及预后判断具有重要意义.     

MRI影像改变对颞叶癫痫术后疗效的影响

目的 研究颞叶癫痫(TLE)患者的MRI影像与病理结果 的相关性,分析不同MRI改变对术后疗效的影响.方法 回顾2005年1月至2008年12月在我科手术治疗且有效随访的121例TLE患者的临床资料,统计分析MRI影像改变与病理结果 的关系;根据MRI影像改变将患者分为内侧型TLE、有结构性改变的TLE和隐源性TLE,利用Engel分级将患者分为无发作组和发作组,比较不同类型TLE患者术后疗效的差异.结果 121例患者中MRI结果 阳性101例,病理结果 阳性107例,二者差异无统计学意义,具有良好的相关性.隐源性TLE患者的术后疗效较内侧型TLE和有结构性病变的TLE差,而后二者之间差异无统计学意义.结论 MRI检查对于TLE的确诊及预后判断具有重要意义.     

MRI影像改变对颞叶癫痫术后疗效的影响

目的 研究颞叶癫痫(TLE)患者的MRI影像与病理结果 的相关性,分析不同MRI改变对术后疗效的影响.方法 回顾2005年1月至2008年12月在我科手术治疗且有效随访的121例TLE患者的临床资料,统计分析MRI影像改变与病理结果 的关系;根据MRI影像改变将患者分为内侧型TLE、有结构性改变的TLE和隐源性TLE,利用Engel分级将患者分为无发作组和发作组,比较不同类型TLE患者术后疗效的差异.结果 121例患者中MRI结果 阳性101例,病理结果 阳性107例,二者差异无统计学意义,具有良好的相关性.隐源性TLE患者的术后疗效较内侧型TLE和有结构性病变的TLE差,而后二者之间差异无统计学意义.结论 MRI检查对于TLE的确诊及预后判断具有重要意义.     

Surgery for temporal lobe epilepsy after cerebral malaria

The most common indication for epilepsy surgery is temporal lobe epilepsy (TLE) which usually is divided into two categories, mesial and lateral TLE. The commonest pathology underlying mesial temporal lobe epilepsy (MTLE) is mesial temporal sclerosis (MTS); we report on a 50-year-old male patient, who contracted cerebral malaria and developed MTLE shortly thereafter. Magnetic resonance imaging (MRI) showed MTS. Surgical treatment was an anteromedial temporal lobe resection with amygdalohippocampectomy. The patient is seizure free, 36 months after surgical treatment. This is the first report describing MTLE-onset subsequent to cerebral malaria and discussing the potential pathophysiological relationship between cerebral malaria and MTS.     

Hyperkinetic seizures in patients with temporal lobe epilepsy: clinical features and outcome after temporal lobe resection

Purpose: Temporal lobe epilepsy (TLE) is usually associated with automatisms. Hyperkinetic seizures are supposed to be unusual. Because we witnessed several patients with TLE and ictal hyperkinetic symptoms, we retrospectively assessed the number, clinical findings, and seizure outcome in such patients who had undergone temporal lobe resection. Methods: We reviewed medical history, video–electroencephalography (EEG) recording and neuroimaging of adult patients who underwent epilepsy surgery for TLE at the Kork Epilepsy Center over the last 20 years with a minimum postoperative follow‐up of 12 months. Key Findings: Among 294 patients who were resected exclusively in the temporal region, we identified 17 (6%) who presented with hyperkinetic semiology such as violent vocalization, complex movements of the proximal segments of the limbs, rotation of the trunk, pelvic thrusting, or early tonic or dystonic posturing. Most of the patients had a preceding aura. Ictal EEG activity was located in the corresponding temporal region, usually with a wide distribution over temporal electrodes with fast spread to unilateral frontal electrodes and to the contralateral side. Neuroimaging revealed extended lesions in the temporal lobe involving mesial and neocortical structures. Most of the patients underwent classical anterior temporal lobe resection including amygdalo‐hippocampectomy. Fourteen patients (82%) became completely seizure‐free (Engel class Ia). Histopathology showed mainly focal cortical dysplasia plus hippocampal sclerosis. Significance: Hyperkinetic seizure semiology may occasionally occur in patients with TLE and is, therefore, no contradiction to the hypothesis of TLE if scalp EEG patterns and neuroimaging findings correspond. The postoperative seizure outcome is favorable in such patients and not different from outcome data in classical TLE.     

Surgical treatment for temporal lobe epilepsy in childhood]

We retrospectively analyzed 5 children (11-15 year) with intractable temporal lobe epilepsy (TLE) who underwent the anterior temporal lobectomy with hippocampectomy. Cases 1-3 had medial TLE (MTLE) with histologically verified hippocampal sclerosis, Case 4 had lateral TLE, and Case 5 had MTLE with old hemorrhagic lesion in the lateral temporal lobe. In Cases 3-5, chronic invasive electrocorticography recording using subdural electrodes was obtained, while in Cases 1 and 2, the epileptogenic region was defined by noninvasive preoperative evaluation. Postoperatively, Cases 1-3 became seizure free. All patients had psychosocial problems after the onset of their epilepsy, which was not improved even after the surgical control of epilepsy. Since most patients had morphological change and perfusional and metabolic disturbance outside the hippocampus at the time of surgery, earlier surgical consideration may be necessary.     

儿童难治性颞叶癫痫的手术治疗

目的 探讨儿童难治性颞叶癫痫术前评估和手术方法 及影响癫痫预后的因素.方法 回顾性分析2007年7月至2009年2月手术治疗的21例儿童难治性癫痫患者中得到随访的19例临床资料,主要为复杂部分性发作.多数患者有腹部不适等发作先兆和咂嘴等发作时伴随自动动作.MRI扫描15例异常.6例行PET扫描均异常.头皮脑电图示局灶痫性放电7例,多灶痫性放电12例.施行一侧颞前叶+海马、杏仁核切除术15例,一侧颞前叶、海马、杏仁核+部分额叶皮层切除术4例.结果 随访12-30个月,癫痫发作结果 ,Engel Ⅰ级13例;Ⅱ级3例;Ⅲ级1例;Ⅳ级2例.随访期间对4例进行神经心理学评估,2例明显好于术前.无永久性神经缺损并发症.术后切除标本病理诊断结果 为颞叶皮层发育不良和颞叶内侧硬化等.结论 颞叶切除治疗儿童难治性癫痫多数预后良好.该手术安全、并发症少.发作表现、EEG以及神经影像学检查对致痫灶定位相互符合时,预示预后良好.早期手术可能对患儿的神经心理学改善有帮助.     

Orbito-frontal epilepsy masquerading as temporal lobe epilepsy-a case report.

Temporal lobectomy fails to control seizures in a considerable percentage of patients who do not have hippocampal sclerosis. One theoretical reason for failure of surgery is that some of these patients may in fact have extratemporal epilepsy. We present a 28-year-old woman with clinical and scalp electroencephalogram (EEG) evidence of right temporal lobe epilepsy (TLE) supported by functional imaging with interictal positron emission tomography (PET) and ictal single-photon emission computerized tomography (SPECT). An invasive EEG monitoring was prompted by the discovery of a small right orbito-frontal lesion on MRI. Monitoring documented seizure onset at the lesion, with rapid right temporal involvement. The patient was almost seizure-free after a lesionectomy. The index of suspicion of orbito-frontal epilepsy should be high in patients with apparent TLE when the scalp EEG and neuroimaging data are not congruent, or if temporal lobe pathology cannot be identified on structural imaging.     

Predictors of outcome after temporal lobectomy for refractory temporal lobe epilepsy

Objective – To identify predictors of outcome after epilepsy surgery in patients with temporal lobe epilepsy (TLE). Methods – Seventy‐six patients with normal magnetic resonance imaging (MRI) or hippocampal sclerosis on MRI who underwent anterior temporal lobe resections were included. Outcome 2 years after surgery was classified as good (Engel I and II) or poor (Engel III and IV). Gender, age at onset and duration of epilepsy, history of febrile convulsions, auras, right‐ or left‐sided TLE, memory ipsilateral to seizure onset (Wada test), hippocampal asymmetry (HA) and T2 relaxation time, amygdala, temporal lobe and hemispheral volume were tested for associations with outcome. Results – Sixty‐seven percent had a good outcome. Of all parameters tested, only a history of febrile convulsions and HA on quantitative MRI were significantly associated with a good seizure outcome. The absence of these parameters did not exclude a good outcome, but only five of 18 patients (28%) without HA and without a history of febrile convulsions had a good outcome. Conclusion – Febrile convulsions and HA were predictors of outcome after epilepsy surgery in TLE. Subtle volume loss in amygdala, temporal lobe or hemispheres and the memory ipsilateral to the side of resection were not associated with outcome.     

Hypersalivation in temporal lobe epilepsy

PURPOSE: We sought to determine whether hypersalivation helps lateralize seizure onset during complex partial seizures of temporal lobe origin. Several clinical signs, which help lateralize seizure onset, have been reported in temporal lobe epilepsy (TLE). Increased salivation only occasionally has been reported as a manifestation of partial epilepsy. METHODS: Of 590 consecutive patients admitted for video-EEG monitoring, either as a part of a presurgical evaluation of medically intractable epilepsy or for diagnosis and clarification of their paroxysmal symptoms, we identified 10 patients with ictal hypersalivation as a prominent manifestation of complex partial seizures. We reviewed the clinical features, scalp-sphenoidal video-EEG monitoring, intracarotid amytal (Wada) testing, hippocampal volumetric magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) scans of these patients. RESULTS: Of the 10 patients with ictal hypersalivation, seven patients had nondominant/right TLE, and three patients had dominant/left TLE. All patients had hippocampal atrophy on volumetric MRI. Eight of the 10 patients underwent standard temporal lobectomy with amygdalohippocampectomy (six right, two left). All of the operated-on patients had a seizure-free (Engel class I) outcome, and their increased salivation resolved. Two patients, who did not undergo surgical treatment, continue to have complex partial seizures with increased salivation. CONCLUSIONS: We conclude that increased salivation as a prominent ictal finding in complex partial seizures of temporal lobe origin is more likely to be of nondominant temporal lobe origin. Further studies with larger numbers of patients are needed to replicate this finding.     

Significance of interictal bilateral temporal hypometabolism in temporal lobe epilepsy

OBJECTIVE: To assess the clinical implications and the pathophysiologic determinants of interictal bitemporal hypometabolism (BTH) in temporal lobe epilepsy (TLE) not associated with bilateral MRI abnormalities or intracranial space-occupying lesions. METHODS: The authors compared the clinical, interictal, and ictal EEG, Wada test, and neuropsychology data of 15 patients with intractable complex partial seizures of temporal lobe origin and BTH with those of 13 consecutive patients with unilateral TLE associated with unilateral temporal hypometabolism (UTH) who remained seizure free for more than 3 years after anterior temporal lobectomy. 18F-fluorodeoxyglucose PET scans were analyzed visually and semiquantitatively, and ratios of counts in individual temporal areas to the rest of the cerebrum were compared with the corresponding values from 11 normal control subjects and with the nonepileptogenic hemisphere of the 13 patients with UTH. BTH was defined as more than 2.5 SDs below control values for two or more temporal areas on each side irrespective of any asymmetry. RESULTS: BTH reflected bilateral independent seizure onset in eight patients (53%). The topography of the metabolic depression was not a reliable predictor of epileptogenicity, but involvement of the inferior temporal gyrus was related specifically to ipsilateral seizure onset (70% sensitivity, 100% specificity). In patients with unilateral TLE, contralateral hypometabolism was associated with longer disease duration and worst memory performance during the Wada test, which amounted to global amnesia after ipsilateral injection in three patients, precluding surgical treatment. Contralateral seizure spread in the ictal EEG was significantly faster in patients with BTH. CONCLUSIONS: In TLE, symmetric or asymmetric BTH may signal bilateral independent seizure onset in approximately half the patients, especially when involving the inferior temporal gyrus. Alternatively, it may reflect an advanced stage of the disease process, characterized by a breakdown of the inhibitory mechanisms in the contralateral hemisphere, and secondary memory deficit associated with higher risk of postoperative memory decline. Patients with TLE and BTH but without bilateral MRI changes may still be operated on successfully, but surgical suitability should be proved by comprehensive intracranial EEG studies and Wada test.     

Distribution of regional gray matter abnormalities in a pediatric population with temporal lobe epilepsy and correlation with neuropsychological performance

OBJECTIVE: The goals of the work described here were to determine if hippocampal and extrahippocampal atrophy in children with temporal lobe epilepsy (TLE) follows a pattern similar to that in adult patients, and to assess the clinical and neuropsychological relevance of regional brain atrophy in pediatric TLE. METHODS: Children with symptomatic TLE (n=14: 9 with mesial TLE due to hippocampal atrophy and 5 with TLE due to neocortical lesions), healthy children (n=14), and 9 adults with mesial temporal lobe epilepsy (MTLE) were compared using voxel-based morphometry (VBM) of brain magnetic resonance imaging (MRI). The children underwent a comprehensive neuropsychological battery. RESULTS: Children with MTLE with unilateral hippocampal atrophy (n=9) exhibited a significant reduction in gray matter in the hippocampus ipsilateral to the seizure origin and significant atrophy in the ipsilateral cingulate gyrus and contralateral middle frontal lobe. Children with TLE (n=14) exhibited a significant reduction in the gray matter of the ipsilateral hippocampus and parahippocampal gyrus. There was a correlation between gray matter volume in children with TLE and scores on several neuropsychological tests. Atrophy in pediatric patients with MTLE was less extensive than that in adults, and involved the hippocampi and the frontal cortex. CONCLUSIONS: Similar to adult MTLE, pediatric MTLE is associated with hippocampal and extrahippocampal cell loss. However, children display less intense quantifiable gray matter atrophy, which affects predominantly frontal lobe areas. There was a significant association between volume of gray matter in medial temporal and frontal regions and scores on neuropsychological tests. In childhood, TLE and the concomitant cognitive/behavior disturbances are the result of a damaged neural network.     

Seizure semiology and electroencephalography in young children with lesional temporal lobe epilepsy

PurposeThis study aimed to discuss the clinical features of seizure semiology and electroencephalography (EEG) in young children with lesional temporal lobe epilepsy (TLE).MethodChildren with lesional TLE received presurgical evaluation for intractable epilepsy. They were followed up for more than one year after temporal lobectomy. We reviewed the medical history and video-EEG monitoring of children with TLE to analyze the semiology of seizures and EEG findings and compared the semiology of seizures and EEG findings of childhood TLE and adult TLE.ResultsA total of 84 seizures were analyzed in 11 children (aged 23–108 months). The age of seizure onset was from 1 month to 26 months (a mean of 17.6 months). All of the patients exhibited prominent motor manifestations including epileptic spasm, tonic seizure, and unilateral clonic seizure. Seven children manifested behavioral arrest similar to an automotor seizure in adult TLE but with a shorter duration and higher frequency. The automatisms were typically orofacial, whereas manual automatisms were rarely observed. The EEG recordings revealed that diffuse discharge patterns were more common in younger children, whereas focal or unilateral patterns were more typical in older children. All of the patients were seizure-free after temporal lobectomy with more than one-year follow-up. All of the children had a mental development delay or regression; however, there was improvement after surgery, especially in those with surgery performed early.ConclusionIn contrast to TLE in adults, young children with lesional TLE probably represent a distinct nosological and probably less homogeneous syndrome. Although they had generalized clinical and electrographic features, resective epilepsy surgery should be considered as early as possible to obtain seizure control and improvement in mental development.     

Emotional facial paresis in temporal lobe epilepsy: its prevalence and lateralizing value.

The selection of patients with medically refractory temporal lobe epilepsy (TLE) for surgery depends on the concordance of data from clinical, imaging and electroencephalographic evaluation. Though clinical examination is often normal, emotional facial paresis has been described in patients with TLE. Utilizing a well-characterized group of mesial TLE (MTLE) patients, who have achieved excellent seizure outcome following anterior temporal lobectomy with amygdalohippocampectomy (ATL), we investigated the prevalence, predictive value and associations of emotional facial paresis. When compared to 8 out of 50 control subjects (16%), 36 out of 50 MTLE patients (72%) exhibited unilateral emotional facial paresis; the difference was highly significant (P<0.0001). The presence of contralateral emotional facial paresis correctly predicted the side of ATL in 86.1% patients. The occurrence of emotional facial paresis was significantly associated with longer duration of epilepsy prior to ATL and left ATL. Our observations confirm that emotional facial parersis contralateral to the side of mesial temporal sclerosis (MTS) is a valuable localizing sign in correctly predicting the epileptogenic temporal lobe. We hypothesize that the presence of an intact right hemisphere and pathological changes more extensive than MTS may be required for emotional facial paresis to readily manifest.     

Somatosensory auras in refractory temporal lobe epilepsy

PURPOSE: To determine the prevalence, manifestations, lateralizing value, and surgical prognostic value of somatosensory auras (SSAs) in patients with refractory temporal lobe epilepsy (TLE). METHODS: Eighty-one consecutive patients undergoing temporal lobectomy for refractory complex-partial seizures were screened for SSAs. The characteristics of the somatosensory phenomena, occurrence of other aura types, seizure semiology, findings of EEG and imaging studies, temporal lobe neuropathology, and postoperative seizure outcome were determined in each patient with SSAs. RESULTS: Nine (11%) of 81 patients with refractory temporal lobe seizures reported distinct SSAs as part of their habitual seizures. The most common manifestation of SSAs was tingling (eight of nine, 89%), but sensory loss (one of nine, 11%) and pain (one of nine, 11%) also were reported. Five patients had unilateral somatosensory symptoms, and four patients had bilateral somatosensory symptoms. Seizure origin was in the contralateral temporal lobe in four (80%) of five patients with unilateral SSAs, including all patients with unilateral SSAs affecting a limb. Partial temporal lobe resection produced complete seizure remission in all nine (100%) patients 1 year after surgery and in seven (78%) of nine patients 2 years after surgery. CONCLUSIONS: SSAs occur more frequently than previously appreciated in patients with refractory temporal lobe seizures and usually manifest as either unilateral or bilateral tingling. In patients with temporal lobe seizures, unilateral SSAs involving a limb suggest a seizure origin in the contralateral temporal lobe. The surgical outcome of TLE patients with SSAs is favorable. Thus the presence of SSAs should not serve as a deterrent to temporal lobe resection in patients with clearly defined TLE.     

发作间期PET对难治性颞叶癫痫的诊断价值

目的分析18例颞叶癫痫患者的正电子发射断层扫描(PET)结果.方法 18例难治性癫痫患者,根据临床症状、脑电图/录像脑电监测(EEG/VEEG)、MRI海马相和单光子发射计算机体层摄影(SPECT)检查诊断为颞叶癫痫.均进行PET检查,结果有16例显示不同程度的颞叶前中部和(或)内侧部的低代谢区域.所有患者均在手术显微镜下采用显微外科技术进行手术,其中右侧颞叶癫痫16例行标准前颞叶及海马杏仁核切除术,左侧颞叶癫痫2例行选择性海马杏仁核切除术.结果随诊观察6～26个月,按照Engel的疗效判断标准,结果I级(癫痫发作消失)11例,II级(极少发作)4例,III级(发作减少75%以上)2例,IV(无改变)1例.结论对于临床上怀疑为颞叶癫痫而上述常规检查方法不能明确癫痫灶者,PET能更好地帮助诊断.     

Prognostic factors in anterior temporal lobe resections for mesial temporal lobe epilepsy: multivariate analysis

PURPOSE: Even though there have been several studies on the prognostic factors of temporal lobe epilepsy (TLE) after lobectomy, no studies have been performed for homogeneous mesial TLE. Furthermore, most studies on the predictors of outcome of epileptic surgery were based on univariate analyses and did not consider modern epileptic surgery investigation modalities such as brain magnetic resonance imaging (MRI) and positron emission tomography (PET). We attempted to identify the prognostic factors in anterior temporal lobectomy (ATL) for mesial TLE with multivariate analysis. METHODS: Ninety-three patients with mesial TLE (54 men and 39 women, mean age at surgery, 28.3 +/- 8.2 years) were included in the study. The primary outcome variable was the status of patients in the second postoperative year, classified as either seizure free (except aura), or not seizure free. Clinical, electroencephalographic, MRI, PET, Wada test, and pathological data were considered. RESULTS: Seventy-eight (84.0%) patients had remission of seizures. With univariate analysis, age at surgery (p < 0.001), epilepsy duration before surgery (p = 0.04), and ipsilateral hippocampal sclerosis on MRI (p = 0.02) were found to be significant. By using multivariate analysis, age at surgery (p = 0.001) and ipsilateral hippocampal sclerosis on MRI (p = 0.03) were found to be the most significant prognostic factors. CONCLUSIONS: Age at surgery and hippocampal sclerosis are independent prognostic factors for ATL in mesial TLE. These findings suggest that mesial TLE may be a progressive disorder, and surgical outcome is better when early ATL is performed.     

Secondarily generalized seizures in temporal lobe epilepsy

Purpose: Secondarily generalized tonic–clonic seizure (SGTCS) may occur rarely in temporal lobe epilepsy (TLE), but SGTCS is the major risk factor for sudden death and for seizure‐related fatal injuries. Our aim was to investigate clinical factors associated with the occurrence of SGTCS in TLE by addressing two questions: (1) What clinical features differentiate patients with TLE who regularly had SGTCS from those who did not? (2) Is there an association of secondarily generalized seizures with preceding seizure elements and clinical data? Methods: We included 171 patients with TLE (mean age 34.4 ± 10) who participated in our presurgical evaluation program, which included continuous video–electroencephalography (EEG) and magnetic resonance imaging (MRI). Patients had a temporal lobectomy as a result of mesial or neocortical TLE. To reevaluate the archived seizures, we selected the consecutively recorded seizures of each patient. If the patient had more than three recorded seizures, then we reevaluated only the first three. Altogether video‐recorded seizures of 402 patients were reanalyzed. Key Findings: A positive association between the presence of hippocampal sclerosis on the MRI and SGTCS in the patient history was found, whereas ictal speech and pedal automatism showed a negative association with a SGTCS history. The age of patients showed a positive association, whereas patient’s reactivity before and during the seizure, oral/pedal automatisms, and vocalizations showed a negative association with secondary generalization of a focal‐onset seizure during video‐EEG monitoring. Significance: Clinical features associated with SGTCS may help clinicians during presurgical monitoring identify high‐risk patients for SGTCS. Our study may help in understanding the pathophysiology of secondary generalization.     

Volumetric evidence of bilateral damage in unilateral mesial temporal lobe epilepsy

PURPOSE: We sought to analyze the contralateral volumes of the temporal pole, posterior segment of the temporal lobe, amygdala, hippocampus, and parahippocampal gyrus in patients with temporal lobe epilepsy (TLE) due to histologically proven mesial temporal lobe sclerosis (MTLS), seizure free for >or=4 years of postsurgical follow-up. METHODS: Forty-six (23 male) TLE patients, operated on between 1996 and 2001, with histopathologic diagnosis of MTLS, and a postsurgical follow-up of >or=4 years, had their temporal lobe structures manually segmented, measured, and compared with those of 23 normal volunteers, paired as groups for sex, age, and handedness. RESULTS: The mean volumes of the contralateral temporal pole, hippocampus, and parahippocampal gyrus in TLE patients were significantly lower than those in controls. CONCLUSIONS: MRI volumetric data show that the damage in TLE due to MTS may be more widespread and bilateral, even in patients with unilateral TLE by clinical and neurophysiological criteria. Our results are relevant to the discussion of epileptogenic mechanisms in TLE.     

Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 1 Structural neuroimaging

The objective of part one of this review is to present the structural neuroimaging techniques that are currently used to evaluate patients with temporal lobe epilepsy (TLE), and to discuss their potential to define patient eligibility for medial temporal lobe surgery. A PubMed query, using Medline and Embase, and subsequent review, was performed for all English language studies published after 1990, reporting neuroimaging methods for the evaluation of patients with TLE. The extracted data included demographic variables, population and study design, imaging methods, gold standard methods, imaging findings, surgical outcomes and conclusions. Overall, 56 papers were reviewed, including a total of 1517 patients. This review highlights the following structural neuroimaging techniques: MRI, diffusion-weighted imaging, tractography, electroencephalography and magnetoencephalography. The developments in neuroimaging during the last decades have led to remarkable improvements in surgical precision, postsurgical outcome, prognosis, and the rate of seizure control in patients with TLE. The use of multiple imaging methods provides improved outcomes, and further improvements will be possible with future studies of larger patient cohorts.