Early provoking factors of epileptogenesis in mesial temporal lobe epilepsy
https://doi.org/10.17749/2077-8333/epi.par.con.2026.264
Abstract
Mesial temporal lobe epilepsy (MTLE) is a severe form of focal epilepsy, often therapy-resistant, resulting from a long-term epileptogenesis. This clinical lecture examines the key early provoking factors of MTLE development: prolonged febrile seizures in childhood, neuroinfections, perinatal hypoxia, and traumatic brain injuries. The universal pathophysiological mechanisms triggered by these factors are analyzed in detail: excitotoxicity, neuroinflammation, blood-brain barrier disruption, aberrant neurogenesis, synaptic reorganization, and the central role of mammalian target of rapamycin (mTOR) signaling pathway hyperactivation. MTLE pathogenesis is explained from the perspective of the “dual/multiple hit” model, according to which the cumulative impact of several injuries leads to the depletion of the hippocampal compensatory capabilities and the formation of hippocampal sclerosis. The importance of comprehensive diagnosis, including detailed history collection, magnetic resonance imaging according to epileptology protocol, and the search for biomarkers is emphasized. Treatment prospects are related to shifting focus towards predictive and preventive therapy targeting key molecular pathways (pro-inflammatory cytokines, mTOR signaling), paving the way for personalized disease management.
About the Authors
A. S. Kotov
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Alexey S. Kotov - Dr. Sci. Med., Assoc. Prof.
61/2 Shchepkin Str., Moscow 129110
Scopus Author ID 25926388600
К. V. Firsov
Moscow Regional Research and Clinical Institute
Russian Federation
Russian Federation
Konstantin V. Firsov - PhD.
61/2 Shchepkin Str., Moscow 129110
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Review
For citations:
Kotov A.S., Firsov К.V. Early provoking factors of epileptogenesis in mesial temporal lobe epilepsy. Epilepsy and paroxysmal conditions. 2026;18(1):72-81. (In Russ.) https://doi.org/10.17749/2077-8333/epi.par.con.2026.264
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