title: Surgical outcome in adolescents with mesial temporal sclerosis: Is it different?
abstract: There are extensive studies evaluating mesial temporal sclerosis (MTS) in adults and limited studies in children, with adolescents being included within both patient populations. Our aim was to evaluate predictors of surgical outcome solely in adolescent patients with MRI- and pathology -proven MTS. The Yale Epilepsy Surgery Database was reviewed from 1987 to 2012 for adolescent patients with confirmed MTS on MRI and pathology who underwent temporal lobectomy and had greater than two-year postsurgical follow-up. Clinical and electrographic data were reviewed. Eighteen patients were identified. Eleven patients (61%) were seizure-free. All seven patients (39%) who were not seizure-free free were found to have lateralized ictal onset within one hemisphere involving two or more lobes on scalp EEG (p<0.001). Of the 7 patients who were not seizure-free, 4 had a history of status epilepticus (compared to 1/11 seizure-free patients; p=0.047), and 4 had lateralized hypometabolism involving two or more lobes within a hemisphere seen on PET (compared to 0/8 seizure-free patients; p=0.002). A novel finding in our study was that lateralized (rather than localized) ictal onset on scalp EEG, lateralized hypometabolism on PET, and history of status epilepticus were risk factors for not attaining seizure freedom in adolescents with MTS who underwent temporal lobectomy.
authors.affiliation: Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, United States. Electronic address: pue.farooque@yale.edu.
authors.forename: Pue
authors.initials: P
authors.lastname: Farooque
authors.affiliation: Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hirsch
authors.affiliation: Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Levy
authors.affiliation: Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Francine
authors.initials: F
authors.lastname: Testa
authors.affiliation: Comprehensive Epilepsy Center, Dept. of Neurology, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Mattson
authors.affiliation: Comprehensive Epilepsy Center, Dept. of Neurosurgery, School of Medicine, Yale University, Yale-New Haven Hospital, New Haven, CT, United States.
authors.forename: Dennis
authors.initials: D
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016208:Databases, Factual; D004569:Electroencephalography; D004833:Epilepsy, Temporal Lobe / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013226:Status Epilepticus / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D013702:Temporal Lobe / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adolescents; Epilepsy surgery; Mesial temporal sclerosis; Outcome