We read with interest the ARCHIVES article by Dr Dlugos.1 We would like to make an additional comment and provide new data to point out the prognostic value of the diagnosis of hippocampal sclerosis (HS) in patients with medically refractory epilepsy. As he mentioned, we demonstrated that temporal lobe epilepsy (TLE) carries a very poor prognosis.2 However, an interesting result of our study was that HS is the most significant prognostic factor in epilepsy. Van Paesschen et al3 have also pointed out the major role of HS in the development of medically refractory epilepsy. Recent data on this subject came from the description by Barsi et al4 of new types of hippocampal abnormalities (HA) that may have major clinical consequences. Some of the patients with TLE might have HA consisting of incomplete folding or abnormal shape or orientation of the hippocampal formation. The pathophysiologic characteristics and clinical profile of the patients with HA may be different from those of patients with pure HS.
Semah F, Lamy C, Demeret S. Hippocampal Sclerosis and Other Hippocampal Abnormalities in the Early Identification of Candidates for Epilepsy Surgery. Arch Neurol. 2002;59(6):1042-1043. doi: