Presurgical evaluation and surgical outcome of temporal lobe epilepsy.
The authors analyzed 22 patients younger than 18 years of age with temporal lobe epilepsy (TLE) treated surgically. Patients underwent a comprehensive presurgical evaluation, including video-electroencephalogram. Fifty-five percent had a history of febrile seizures. Eighty-two percent had auraes and most exhibited oroalimentary and gestural automatisms. Contralateral dystonic posturing was present in 36% and postictal dysphasia in 54% of patients with left-sided resections. Cranial magnetic resonance imaging (MRI) was abnormal in 59% of patients. MRI revealed changes consistent with mesial temporal sclerosis in 8 (47%) of 17 patients without lesions. Fluorodeoxyglucose-positron emission tomography (PET) scans revealed ipsilateral temporal hypometabolism (PET-TH) in 12 (85.7%) of 14 patients. The intracarotid amobarbital procedure revealed impaired memory of the epileptogenic side in 59% of patients. Seventeen patients underwent en-bloc resections and five lesionectomies and resection of the epileptogenic area. There was no surgical morbidity or mortality. Forty-three percent had hippocampal sclerosis, 28.5% gliosis, 14% low-grade tumors, 9.5% cavernous angiomas, and 5% had no pathologic findings. Follow-up (6 months to 12 years) was available for 21 patients; 76% became seizure free, 19% had rare seizures, and 5% had a worthwhile improvement. TLE can be safely treated surgically in younger patients with excellent results. The clinical manifestations were similar to adult patients. PET-TH was present even at a younger age, suggesting that the focal functional deficits appear early in patients with medically refractory TLE, which may help in the early identification of these patients.
Salanova
V
V
Department of Neurology, Indiana University School of Medicine, Indianapolis, USA.
Markand
O
O
Worth
R
R
Garg
B
B
Patel
H
H
Asconape
J
J
Park
H M
HM
Hutchins
G D
GD
Smith
R
R
Azzarelli
B
B
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000654:Amobarbital; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002648:Child; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011612:Psychosurgery; D012598:Sclerosis / Q000150:complications; D003294:Seizures, Febrile / Q000209:etiology; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D000654:Amobarbital