The network nature of focal epilepsy is exemplified by mesial temporal lobe epilepsy (mTLE), characterized by focal seizures originating from the mesial temporal neocortex, amygdala, and hippocampus. The mTLE network hypothesis is evident in seizure semiology and interictal comorbidities, both reflecting limbic network dysfunction. The network generating seizures also supports essential physiological functions, including memory, emotion, mood, and sleep. Pathology in the mTLE network often manifests as interictal behavioral disturbances and seizures. The limbic circuit is a vital network, and here we review one of the most common focal epilepsies and its comorbidities. We describe two people with drug resistant mTLE implanted with an investigational device enabling continuous hippocampal local field potential sensing and anterior nucleus of thalamus deep brain stimulation (ANT-DBS) who experienced reversible psychosis during continuous high-frequency stimulation. The mechanism(s) of psychosis remain poorly understood and here we speculate that the anti-epileptic effect of high frequency ANT-DBS may provide insights into the physiology of primary disorders associated with psychosis.

Bioelectronic Neurophysiology and Engineering Laboratory Department of Neurology Mayo Clinic Rochester MN United States

Czech Institute of Informatics Robotics and Cybernetics Czech Technical University Prague Czechia

Department of Neurologic Surgery Mayo Clinic Rochester MN United States

Department of Physiology and Biomedical Engineering Mayo Clinic Rochester MN United States

Department of Radiology Mayo Clinic Rochester MN United States

Departments of Psychiatry and Psychology Mayo Clinic Rochester MN United States

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