Despite extensive research on temporal lobe epilepsy (TLE), most work focuses on treatment outcomes and their determinants. Detailed evaluation of causal factors has not been adequately addressed in most published studies. This study aimed to explore potential etiologic risk factors for TLE through a chart review of prospectively collected data from a Canadian epilepsy clinic.

Consecutive patients diagnosed with TLE at a Canadian epilepsy clinic were included. Consecutive patients with genetic generalized epilepsy (GGE) served as a comparison group. The study database comprised prospectively collected demographic and epilepsy data, including birth history, development, antecedents, imaging and EEG findings. Statistical analysis compared antecedent factors between the TLE and GGE groups.

Eighty-nine TLE patients (mean age 42.3 ± 15.9 years, 45M), and 69 GGE patients (mean age 32.8 ± 14 years, 36M) were included. TLE was strongly associated with prior significant head trauma (p < 0.001) and seizure following major neurological insult (p = 0.044). MRI showed mesial temporal sclerosis in 13 TLE patients (14.6%) and was normal in 45 (50.5%). Among EEG abnormalities in TLE, 48% localized to the posterior temporal region.

Significant head trauma and early post-insult seizures were the strongest associated risk factors for TLE in this Canadian cohort.