Seizure-free and neuropsychological outcomes after temporal lobectomy with amygdalohippocampectomy in pediatric patients with hippocampal sclerosis.
OBJECTIVE
Temporal lobe epilepsy is an uncommon clinical syndrome in the pediatric population. The most common underlying pathologies include low-grade gliomas, cortical dysplasia, and, less commonly, hippocampal sclerosis (HS). There is a paucity of data on neuropsychological and seizure-free outcomes in these patients after temporal lobectomy. In this study, the authors reviewed their seizure-free and neuropsychological outcomes after temporal lobectomy for pediatric HS.


METHODS
The authors retrospectively reviewed the medical records of pediatric patients with HS who underwent anterior temporal lobectomy and amygdalohippocampectomy between 1998 and 2011 at the Cleveland Clinic. Results of neuropsychological assessment before and after surgery and seizure-free outcome at last follow-up were obtained.


RESULTS
Forty-five patients met the inclusion criteria. Thirty-four (76%) patients had pathology of HS alone and 10 (22%) had HS and cortical dysplasia. The mean duration of follow-up was 60.2 months. Eighty-four percent of patients had postoperative Engel Class I or II outcomes. Neuropsychological outcomes remained unchanged or minimally improved postoperatively.


CONCLUSIONS
Seizure-free outcomes in pediatric HS are similar to historical rates in adult HS. Neuropsychological assessments remain stable after temporal lobectomy. Standard temporal lobectomy should be considered in pediatric patients with medically intractable epilepsy secondary to HS.
Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Sumeet
S
Vadera
Varun R
VR
Kshettry
Patricia
P
Klaas
William
W
Bingaman
D000293:Adolescent; D000679:Amygdala / Q000601:surgery*; D038481:Anterior Temporal Lobectomy; D002648:Child; D002675:Child, Preschool; D004833:Epilepsy, Temporal Lobe / Q000209:etiology / Q000601:surgery*; D005260:Female; D006624:Hippocampus / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012598:Sclerosis / Q000150:complications / Q000601:surgery; D012640:Seizures; D016896:Treatment Outcome