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• W4317937370 abstract "Hippocampal sclerosis is the most frequent etiology of patients with drug-resistant mesial temporal lobe epilepsy, which is the most frequent localization for focal epilepsy. Hippocampal sclerosis is the consequence of a cerebral aggression during early childhood, called the initial precipitating event, the most frequent of which are: febrile seizure, intracranial infection, hypoxia, or cranial trauma. The epilepsy onset usually occurs a few years after this event, with an association of focal temporal seizures and rarer secondarily generalized tonic-clonic seizures. Most patients have a drug-resistant focal epilepsy, with a failure of two different and adequate antiepileptic drugs to achieve seizure freedom. Patients also demonstrated with cognitive impairment, with a typical episodic memory impairment affecting both verbal and non-verbal episodic memory. Cognitive impairment is however more diffuse than the sole episodic memory impairment, and also affects language, visuo-spatial processing, and executive functions. With aging, subjects demonstrated a progressive cognitive decline, that appears to parallel the decline associated with normal aging, but starts earlier and from a lower global cognitive functioning with less cognitive reserve. Patients may therefore reach an impairment threshold sooner than healthy subjects, and are much more vulnerable to any other disease that impairs cognitive functioning. Patients exhibited cortical and subcortical atrophy patterns on volumetric brain MRI similar to normal aging in its distribution, but with an earlier pattern of atrophy (4.5 years sooner in patients than in healthy subjects). Hippocampal sclerosis is associated with amyloid and tau deposits inside the hippocampus, which increases with the subjects’ age. Those deposits pattern is close to the one observed in patients with tau / amyloïd neurodegenerative diseases, which demonstrates a bilateral relationship between epilepsy, hippocampal sclerosis, and neurodegenerative diseases. Clinical consequences of such a relationship are yet to be precisely determined.La sclérose hippocampique est l’étiologie la plus fréquente de l’épilepsie focale temporale mésiale. Elle est souvent la conséquence d’un évènement initial précipitant durant la petite enfance (crises fébriles, infection intracrânienne, hypoxie cérébrale, traumatisme crânien…). L’épilepsie débute ensuite, après un intervalle libre de quelques années, vers la fin de l’enfance ou le début de l’adolescence, et est très souvent pharmacorésistante. Il s’y associe des troubles mnésiques s’étendant au-delà d’une atteinte hippocampique isolée, avec une atteinte des fonctions exécutives, visuo-spatiales et du langage. Avec l’âge, les fonctions cognitives de ces sujets suivent une trajectoire évolutive parallèle à celle observée dans le vieillissement physiologique, mais avec un maximum de performance plus faible et un déclin plus précoce de quelques années, ce qui induit une réserve cognitive moins importante. La distribution de l’atrophie liée à l’âge est identique à celle des sujets sains, mais décalée dans le temps (plus précoce de 4,5 ans). De plus, la sclérose hippocampique est associée à la présence de dépôts intra-hippocampiques de protéines Tau et de peptide amyloïde, ressemblant à ce qui est observé chez les patients souffrant d’une pathologie neurodégénérative tau/amyloïde, augmentant avec l’âge et dont les conséquences cliniques restent encore à déterminer." @default.
• W4317937370 created "2023-01-25" @default.
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• W4317937370 date "2022-12-01" @default.
• W4317937370 modified "2023-10-07" @default.
• W4317937370 title "Sclérose hippocampique associée à l’épilepsie : conséquences cliniques, histopathologie et évolution avec l’âge" @default.
• W4317937370 doi "https://doi.org/10.1684/pnv.2022.1072" @default.
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