Abstracts

There is a paucity of prospective data on outcome for children with new-onset temporal lobe epilepsy (TLE), particularly regarding intractability and the need for epilepsy surgery. We previously characterized a cohort of 63 children with new-onset TLE (Neurology 1997;49:960-8) and followed them prospectively. Age at seizure onset was 0.2-14 (median 6.4) years and mean delay from onset to recruitment was 1.2 years. MRI was performed at recruitment in 58 children; only CT in the remainder. Lesions on MRI were present in 23 children, presumptive diagnoses including tumor in 8, hippocampal sclerosis (HS) in 13, dysplasia in 1 and arachnoid cyst in 1. Three children with HS had dual pathology, additional lesions being porencephaly in 1, caudate atrophy in 1 and parieto-occipital atrophy in 1. Eighteen children had significant antecedents, including complicated febrile convulsions in 5 and cerebral infection in 5, 12 /18 having HS. FSIQ ranged from 48-145 (mean 100). Seizure frequency at recruitment was daily in 9, weekly in 15, monthly in 26 and quarterly or less in 13. Children were reassessed approximately 5 and 10 years following recruitment, recognizing that refractory patients were more extensively reevaluated. 20/63 (32%) children had undergone epilepsy surgery. These children were aged 1.5-13 (median 7) years at seizure onset and 5.7-21 (median12) years at surgery. TLE duration prior to surgery was 0.3-14 (median 5.9) years. Nineteen children had lesions on MRI at recruitment; 1 child with apparent normal MRI at recruitment was diagnosed with tuberous sclerosis on repeat imaging. Surgery was temporal lobectomy in 13 and corticectomy or lesionectomy in 8. Histologically-confirmed lesions were HS in 7, DNET in 3, ganglioglioma in 2, astrocytoma in 2, cortical dysplasia in 6 and Rasmussen encephalitis in 1.
In the non-surgery group, only 4/42 had lesions on MRI (p[lt]0.001), all having refractory seizures. There were no significant differences between the surgery and non-surgery groups with respect to patient demographics, age at seizure onset, pretreatment seizure frequency or FSIQ. Lesion on MRI predicts surgical treatment for seizure intractability in new-onset TLE in childhood. Demographic, seizure and intellectual factors are not predictive. (Supported by Neurological Foundation of New Zealand.)