Abstracts

Rationale: Basal ganglia (BG) injury is a rare but well-recognized complication of temporal lobectomy. In the setting of temporal lobe (TL) tumors, the risk of this complication is increased due to distortion of normal anatomy and vasculature near the temporal stem. However, little is known about the long-term sequelae after such injury, the effects of epilepsy, or the results of subsequent epilepsy surgery on movement disorder (MD). We describe two children with medically intractable epilepsy (MIE) due to temporal lobe tumors, who presented with BG strokes after partial tumor resection. Both patients experienced significantly different MD outcomes before and after subsequent TLE surgery. Methods: A retrospective review of patients with TL tumors and MIE, who had been referred to the Comprehensive Pediatric Epilepsy Center at Beth Israel Medical Center in New York, was performed. Two patients were identified who had suffered basal ganglia strokes as a complication of prior temporal lobe tumor surgery at other institutions. Pre and post-operative evaluations included VEEG, MRI, PET scans, fMRI, and follow-up with MD specialists. Results: A 19 yo M (Pt 1) and a 5 yo F (Pt 2) were included in this study. Duration of epilepsy was 14 years in Pt 1 and 4 years in Pt 2. Pt 1 had undergone prior TL tumor surgery at age 10 followed by epilepsy surgery at age 12, which was complicated by traumatic BG injury; at presentation to our institution, he suffered from disabling complex partial seizures (CPS) of 14 years duration, and severe dystonia of the LUE refractory to botulinum toxin. Pt 2 had undergone left temporal tumor resection at age 1, complicated by BG infarction; she presented to our institution with a right hemiparesis and medically intractable simple and CPS involving the RUE (50/day). Both children had a decline in school performance and deterioration in cognitive and language measures on neuropsychological testing. Under our care, Pt 1 underwent staged epilepsy surgery including right anterior temporal lobectomy (ATL) and amygdalohippocampectomy (AH), and has been seizure free (Engel IA) at 5 years F/U. After epilepsy surgery, dystonia has decreased dramatically, with only residual stiffness of the left hand. Pt 2 underwent staged epilepsy surgery at our institution, with a left ATL, AH, and frontal disconnection. She is seizure free (Engel IA) at 1 year F/U, but in contrast to Pt 1, a MD characterized by choreoathetosis of the RUE manifested after epilepsy surgery. Both patients have had significant improvement in language and cognitive measures. Conclusions: The relationship between MD and epilepsy is poorly understood. Our two patients with MIE and benign temporal tumors experienced significantly different MD histories after BG stroke and subsequent epilepsy surgery. Distortion of mesial temporal structures by tumor, age at the time of injury, degree of BG damage, and extent of subsequent epilepsy surgery are postulated to play a role in the variable expression of MD in this setting.