Clinical Evaluation of the Association Between Prolonged Febrile Seizures and Mesial Temporal Sclerosis in Patients with Mesial Temporal Lobe Epilepsy: A Prospective Observational Study Using Imaging Modalities

Abstract

Introduction: Febrile seizures (FS), the most common form of childhood seizures, are categorized into two types: simple and atypical FS. Prolonged febrile seizures (lasting more than 30 minutes), specifically febrile status epilepticus, have been associated with mesial temporal lobe epilepsy (mTLE) due to neuronal loss, gliosis, and hippocampal atrophy occurring in early life.

Aim of the study: This study aimed to clinically evaluate the association between prolonged febrile seizures and mesial temporal sclerosis (MTS) in patients with mesial temporal lobe epilepsy (mTLE) using MRI of the brain.

Methods: A prospective cross-sectional observational study was conducted at the epilepsy clinic, Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), from February 2021 to May 2022.

Results: The study included 84 patients diagnosed with temporal lobe epilepsy (TLE). Among them, 58 patients had MRI-confirmed mesial temporal sclerosis (MTS) on epilepsy protocol imaging. Of these 58 mTLE patients, 35 (60%) had right-sided MTS, while 23 (40%) had left-sided MTS. The age range of the patients was 18-60 years, with 37 males and 21 females. A positive history of prolonged febrile seizures was found in 38 (45%) patients.

Conclusion: A history of prolonged febrile seizures appears to be a significant causative factor for the later development of hippocampal damage and mesial temporal lobe epilepsy (mTLE). This study demonstrates that MRI findings show a notable association between prolonged febrile seizures in childhood and mesial temporal sclerosis in patients with mesial temporal lobe epilepsy.