Temporal lobe epilepsy surgery in children and adolescents: clinical characteristics and post-surgical outcome.
OBJECTIVE
Temporal lobe epilepsy (TLE) encompasses 10-20% of the cases of intractable epilepsy in pediatric patients. Mesial temporal sclerosis (MTS) can still be encountered in adolescent patients, but is rare in children under 5 years of age. In this paper we report on the surgical outcome of a series of TLE patients ranging in age from 1 to 18 years at the time of operation.


METHODS
Thirty-five patients (37 surgeries) with medically intractable TLE were operated upon between January 1996 and December 2002. The following variables were analyzed: age at surgery, age at epilepsy onset, history of an initial precipitating injury, etiology, seizure semiology, interictal and ictal EEG findings, surgical complications, and post-surgical seizure outcome.


RESULTS
There were 68.6% females and 31.3% males, and complex partial seizures (CPS) occurred in 86.5%. The most common etiology was MTS (40%) followed by isolated cortical developmental abnormalities (22.9%). In the age group up to 5 years, cortical development abnormalities predominated, and 71% of these children had multifocal interictal EEG. Patients older than 10 years had more frequently MTS (78.6%) and focal temporal interictal EEG abnormalities. Post-surgical seizure outcome showed that 88.5% of patients were in Engel classes I and II.


CONCLUSIONS
Adolescents with TLE had clinical features, electrographic findings, and seizure outcome similar to those observed in adult patients. However, younger children up to 5 years of age had distinct ictal semiology and different etiological, electrophysiological and outcome profiles, clearly suggesting that they behave as a special subgroup within the TLE.
Terra-Bustamante
Vera Cristina
VC
Department of Neurology, Hospital das Clinicas, Av Bandeirantes, 3900 Monte Alegre, Brazil. vctbusta@rnp.fmrp.usp.br
Inuzuca
Luciana M
LM
Fernandes
Regina M F
RM
Funayama
Sandra
S
Escorsi-Rosset
Sara
S
Wichert-Ana
Lauro
L
Santos
Antonio C
AC
Araujo
David
D
Machado
Helio R
HR
Sakamoto
Americo C
AC
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D009493:Neurosurgery / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome