Long-term seizure and social outcomes following temporal lobe surgery for intractable epilepsy during childhood.
OBJECTIVE
Studies of adults who underwent temporal lobectomy for intractable temporal lobe epilepsy (TLE) demonstrated declining seizure free rates over time. Using seizure and social parameters, we followed patients who had temporal lobe surgery (TLS) in childhood to determine long-term outcomes.


METHODS
We identified 42 patients who underwent TLS for medically intractable epilepsy during childhood. Follow-up data were collected from 10 to 20 years after surgery (median, 12 years). We studied histopathology, seizure outcome, employment, school enrolment, and driver's licensing. Patients or parents graded their satisfaction with TLS.


RESULTS
Number of Engel class I patients was 34 (81%) after 6 months; 32 (76%) after 1 year; 30 (71%) after 5 years; and 28 (67%) at last >or=10 years follow-up. Nineteen (79%) of 24 children with tumors or cavernous angioma achieved class I outcomes in contrast to 9 (50%) of 18 children with other pathologies (p<0.05). Ten (56%) of 18 recurrent seizure patients experienced seizures within the first year; 4 required reoperation for seizure freedom. More seizure free patients (24, 86%) than residual seizure patients (8, 57%) were employed or in school (p=0.05). Twelve (63%) of 19 eligible patients obtained driver's licenses. Twenty-three (82%) of 28 seizure free patients discontinued anticonvulsants. Surgery grading averaged "satisfied." Class I patients reported greater satisfaction than class III/IV patients (p<0.001).


CONCLUSIONS
Two-thirds of children who underwent TLS achieved seizure freedom at >or=10 year follow-up. Children with tumors or cavernous angiomas achieved better long-term outcomes than those with other histopathologies. Long-term seizure free patients were most often satisfied with surgery and employed or in school.
Benifla
Mony
M
Divisions of Neurosurgery and Neurology, The Hospital for Sick Children, University of Toronto, ON, Canada.
Rutka
James T
JT
Otsubo
Hiroshi
H
Lamberti-Pasculli
Maria
M
Elliott
Irene
I
Sell
Eric
E
RamachandranNair
Rajesh
R
Ochi
Ayako
A
Weiss
Shelly K
SK
Snead
O Carter
OC
Donner
Elizabeth J
EJ
D000293:Adolescent; D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D001334:Automobile Driving; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004522:Educational Status; D004651:Employment; D004827:Epilepsy / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007223:Infant; D008032:Limbic System / Q000601:surgery; D008297:Male; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012008:Recurrence; D012074:Remission Induction; D012086:Reoperation; D012917:Social Adjustment; D015173:Supratentorial Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery*
D000927:Anticonvulsants