Mesial temporal lobe epilepsy versus amygdalar epilepsy: late seizure recurrence after initially successful amygdalotomy and regained seizure controlfollowing hippocampectomy

We summarise the concept of mesial temporal lobe epilepsy and the pros and cons in order to define amygdala epilepsy. We present a patient with stereo tactically proven right amygdalar seizure onset, associated with fear and v egetative autonomic signs and symptoms as the most prominent clinical ictal features. Following a right stereotactic amygdalotomy, the patient experie nced,an Ii-year seizure-free period. Similar, but not identical, semeiology of complex partial seizures then recurred. A right-sided selective hippoca mpectomy and excision of the previously lesioned amygdala was performed. Ex cept for 2 complex partial seizures associated with withdrawal of antiepile ptic drugs, the patient remained seizure-free 9.5 years. This case underscores the important role of the amygdala in generating the semiology, and raises several questions concerning the existence of "amygda lar epilepsy". The Ii-year seizure-free, period following the stereotactic destruction of the amygdala is a strong argument for this notion. The late seizure recurrence requiring a second operation might, however, be seen as an argument for the important role of the hippocampal formation in the synd rome of mesial temporal lobe epilepsy even when the amygdala has been ident ified as the seizure onset one. The role of stereotactic amygdalotomy is br iefly reviewed.