Abstracts

Few studies have looked at the long-term epileptic and cognitive outcome of frontal lobe epilepsy in children and most of them are limited by the inclusion of both lesional and non-lesional patients.
: To define the epileptic and functional outcome of children with non-lesional FLE. We reviewed medical and neuropsychological records of patients with FLE diagnosed between 1994-2004. We included children with either focal EEG findings or regional EEG changes and focal functional imaging abnormalities. We reviewed their charts for seizure and neuropsychological outcome. We retrieved 21 children, including 14 boys. Mean age at seizure onset was 6.7 [plusmn] 3.9 years and mean follow-up 9.4 [plusmn] 3.5 years . Cerebral CT /MRI were normal by definition in all children. Ten of 16 with a specified seizure frequency (62.5%) presented with daily seizures. Seizures were nocturnal in 7/21, secondarily generalized in 5/21, adversive in 5/21, and focal motor in 5/21. The initial therapy was Carbamazepine (10), Phenytoin (2), Phenobarbital (1) and valproic acid (3). Although initial seizure control was poor (14/21 failed the initial drug), long-term seizure control was still achieved in 9/21 patients after several months of treatment (14.6 +/- 22.3). Early development was normal in 12/21 children but at latter formal neuropsychological evaluation only 3 of the 12 still had a normal profile. The majority of children had learning difficulty requiring special help prior to seizure onset (52.4%). But a clearly defined regression after seizure onset was observed in only 3 patients. A detailed neuropsychological evaluation was performed in 18/21 patients. The majority exhibited attention deficit and hyperactivity or impulsivity (14/21), behavioural problems (7/21) and cognitive impairments (7/21 low average IQ). Early seizure control was associated with a better outcome Non-lesional FLE is associated with poor seizure, cognitive and behavioural outcomes. Whether this is secondary to MRI-silent developmental lesions or the repercussion of seizures on frontal lobe functions remains uncertain. A prospective study with early neuropsychological assessment could help confirm the latter.