Abstracts

Temporal lobectomy (TL) has been established as a safe and effective treatment for medically intractable temporal lobe epilepsy. However, long term follow-up studies in adults demonstrate declining seizure free rates with increasing time since surgery. A single study of TL in childhood reports 53% seizure freedom at 15 years, declined from 82% at 5 years., A retrospective chart review and prospective telephone interviews were conducted on 42 patients who underwent temporal lobe surgery for medically intractable epilepsy during childhood, with a minimum 10 year follow-up. Data regarding seizure outcome, employment, school and driving history was obtained. Patients or parents were asked to grade their satisfaction with the surgery on a 5 point scale., Mean age at seizure onset was 56 months and mean age at surgery was 132 months. Average seizure duration was 76 months. At one year follow-up, 33 (79%) patients were seizure free, in Engel class 1. At five and ten year follow-up, 31 (73%) and 28 (67%) patients, respectively, were in Engel class I. There was a significant difference in seizure outcome with respect to time passed since surgery (p[lt]0.001). Four patients required a second surgery at 1, 4, 5 and 7 years after the first procedure. No significant difference in the seizure outcome was found with respect to age at seizure onset and at surgery and to seizure duration.
Children with neoplastic lesions had significantly better long term seizure outcome following surgery than children with non-neoplastic lesions, such as mesial temporal sclerosis, cortical dysplasia and gliosis. Twenty (72%) of the 28 patients in Engel class I were engaged in regular employment or education, significantly higher than in the Engel class IV group (42%). 63% of the Engel class I group had obtained a driver[apos]s license. The average satisfaction grade was 4 (satisfied), the mean grade was significantly higher in the seizure free group., Despite declining seizure freedom rates over time, this study supports the use of temporal lobe surgery for medication resistant temporal lobe epilepsy in children, reporting good seizure free rates at 10 year follow-up. Furthermore, our results suggest that seizure freedom following temporal surgery in children is associated with good rates of employment and school enrollment., (Supported by: Mony Benifla was supported by the Wiley Fund at the Hospital for Sick Children.)