MRI evidence of mesial temporal sclerosis in patients with psychogenic nonepileptic seizures

Mesial temporal sclerosis (MTS) is the most common cause of temporal lobe epilepsy, and MRI evidence of MTS is critical in the evaluation for temporal lobectomy.1,2⇓ For those reasons, MRI is now commonly performed specifically for the purpose of identifying MTS. However, the frequency of significant MRI evidence of MTS in patients without seizure (i.e., specificity) is unknown. We report four cases that illustrate an increasingly important pitfall in the evaluation of patients with seizures. Patients were 28 to 35 years of age and had onset of “seizures” between 25 and 30 years of age (duration of seizures 3 to 6 years). They were all referred for possible epilepsy surgery after an MRI showed evidence of MTS. MRI (1.5 tesla) used 1-mm sections and was performed using fast spin echo T2 (repetition time [TR] 5500, echo time [TE] 21.3, 256 × 256 matrix) coronal sequence, inversion recovery sequence (three-dimensional/fast-spin echo gradient recall = 30, TR 10.2, TE 2), axial T2 images at a …