Yağmur Tunçbilekli, Pınar Eser, Nur Balçın, Eray Doğan, Aylin Bican Demir, İbrahim Bora, Ahmet Bekar
Archives of Epilepsy - 2026;32(2):55-60
Objective: Temporal lobe epilepsy (TLE) is the most common focal epilepsy syndrome and remains medically refractory in a substantial proportion of patients. Dual pathology, defined as the coexistence of hippocampal sclerosis with an additional neocortical lesion, is an important cause of surgical failure when not adequately recognized. This study aimed to evaluate the clinical characteristics and postoperative seizure outcomes of patients with dual pathology compared with those with isolated mesial temporal sclerosis. Methods: We retrospectively reviewed 125 patients who underwent surgery for TLE between January 2005 and February 2023. Thirty-one patients with dual pathology, defined as hippocampal sclerosis accompanied by a neocortical tumor, were included. A control group consisted of 34 age-matched patients with isolated mesial temporal sclerosis. Clinical features, seizure characteristics, surgical procedures, postoperative outcomes assessed using the Engel classification, and complications were analyzed. Results: The mean age was similar between the dual pathology and control groups. However, the age at seizure onset was significantly later in patients with dual pathology (26.5+/-15.9 years vs. 9.2+/-7.8 years; p<0.001). Generalized tonic-clonic seizures were more frequent in the dual-pathology group, whereas focal seizures with impaired awareness predominated in patients with isolated mesial temporal sclerosis. Engel class I seizure freedom was achieved in 61.3% of patients with dual pathology and in 67.6% of controls, with no significant difference between groups. Postoperative complication rates were comparable. Conclusion: Despite differences in seizure characteristics and age at seizure onset, postoperative seizure outcomes in patients with dual pathology were comparable to those in patients with isolated mesial temporal sclerosis when both the mesial temporal structures and the associated neocortical lesion were adequately resected. Dual pathology should be considered in patients with TLE who present with mesial temporal sclerosis accompanied by a neocortical tumor, particularly in those with a relatively late age at seizure onset.
