Surgery for medically intractable temporal lobe epilepsy during early life.
OBJECTIVE
Temporal lobe epilepsy (TLE) in early life is often a catastrophic disorder with pharmacoresistant seizures and secondary neurological deterioration. there is little data available regarding epilepsy surgery performed in infants and young children and no prior study has focused on tle.


METHODS
We analyzed the results of temporal resection for epilepsy as the primary indication in children less than age 5 years who had at least 2 years of follow-up.


RESULTS
20 children (14 males) were identified with a mean age at surgery of 26 months and a mean age at seizure onset of 12 months. Clinical presentation was diverse. Typical psychomotor seizures (n = 4; mean age at surgery 37 months) were followed by prominent motor changes (n = 7; 30 months) and were occasionally isolated (n = 3; 23 months). Epileptic spasms were noted in six patients and were frequently associated with lateralizing features. The interictal EEG was lateralizing in 15 patients and the ictal EEG was lateralizing in 18 patients. Brain MRI provided localizing value in 16 patients, ictal SPECT was concordant in 4/8 cases. Invasive EEG was employed in six cases. At mean follow-up of 5.5 years, 65% of the children were seizure-free and 15% had >90% seizure reduction. Morbidity included infection and hydrocephalus in one case and stroke-related hemiparesis in two cases. Cortical dysplasia was identified in eight children, tumors in eight including two DNET, two ganglioglioma, and four malignant tumors. Hippocampal sclerosis was present in four cases, always as dual pathology.


CONCLUSIONS
TLE presents in early life with varied and severe manifestations. Excisional procedures in this age group are associated with favorable seizure reduction similar to older children and in adults.
Maton
Bruno
B
The Brain Institute, Miami Children's Hospital, Miami, Florida, USA.
Jayakar
Prasanna
P
Resnick
Trevor
T
Morrison
Glenn
G
Ragheb
John
J
Duchowny
Michael
M
D000367:Age Factors; D017668:Age of Onset; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000002:abnormalities; D002675:Child, Preschool; D004351:Drug Resistance; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005431:Florida / Q000453:epidemiology; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011300:Preoperative Care; D013238:Stereotaxic Techniques; D013702:Temporal Lobe / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome