Abstracts

The objective of the study was to review our experience and compare the results of the selective amygdalohippocampectomy in children versus adults with refractory temporal lobe epilepsy., A retrospective case series was used in the setting of a tertiary care hospital which provides care to both children and adults. All patients underwent a selective amygdalohippocampectomy performed by a single neurosurgeon and had at least one year of follow up.
Patient charts were reviewed for pertinent clinical information and the data was compared between children and adults. Outcome measures included seizure frequency, neuropsychological assessment, EEG, neuro-imaging and anti-epileptic drugs pre and post-operatively., Twenty three patients, 9 children and 14 adults were studied. Age at surgery varied from 6 to 58 years. Follow-up ranged from 1 to 4 years. Surgical outcome was variable between the two groups. Amongst the younger cohort (6-18 years of age), 5 patients had good outcome (Engel Class I or II), two patients had a poor outcome (Engel class III) and two patients had refractory seizures (Engel Class IV) that required returning to the operating room for a standard anterior temporal lobectomy. This differed from the adults, who all had a good outcome. Ten patients were seizure-free (Engel Class I) and the remainder had rare seizures (Engel Class II).
Non-MTS pathology was more common in children. Thirteen of 14 (93%) had MTS in the adult population, while only 4 of 9 children (44%) had MTS. The pathology at surgery in this group included mesial temporal sclerosis (MTS), brain tumors, focal encephalitis and normal pathology., Selective amygdalohippocampectomy can lead to favorable seizure and neuropsychological outcome in adults with refractory temporal lobe epilepsy. However, preliminary results show less favorable results in children. The difference is probably related to the different pathology between the two groups. Adults most commonly have MTS, whereas children more commonly have non-MTS temporal lobe pathology. Clinicians should be aware of this difference when considering surgical management in children with refractory temporal lobe epilepsy.,