Mesial temporal lobe epilepsy — MRCPsych Paper A MCQ

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EasyNeuroanatomyMesial temporal lobe epilepsyMRCPsych Paper A

A 27-year-old man experiences stereotyped episodes of a rising epigastric sensation and fear, followed by lip-smacking and brief impairment of awareness. MRI shows mesial temporal sclerosis. Which brain structure is characteristically most affected?

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Correct answer: A — Hippocampal formation

The correct answer is **C, hippocampal formation**. A rising epigastric aura followed by fear, impaired awareness and oroalimentary automatisms is characteristic of mesial temporal lobe epilepsy. Mesial temporal sclerosis most characteristically represents hippocampal sclerosis, with neuronal loss and gliosis particularly affecting hippocampal subfields. The primary visual cortex would instead be associated with elementary visual seizure phenomena. The caudate nucleus participates in basal-ganglia motor and behavioural circuits but is not the characteristic site of mesial temporal sclerosis. Dorsolateral prefrontal dysfunction is associated principally with executive impairment rather than this seizure semiology. Cerebellar vermis pathology causes predominantly gait, truncal or coordination abnormalities and does not explain the focal impaired-awareness seizures or MRI finding.

Reference: Villamizar-Torres D, Cepeda Trillos AC, Vargas-Moreno A. Mesial temporal sclerosis and epilepsy: a narrative review. Acta Epileptologica. 2024. https://pubmed.ncbi.nlm.nih.gov/40217409/