Abstracts

We present a retrospective analysis of 49 preadolescents undergoing temporal lobe epilepsy surgery to better define outcomes and prognostic indicators. Data were collected for all children undergoing temporal resections at four epilepsy centers over 10 years. Children with tumors were excluded from analysis. We confirmed MTS (n=26), gliosis (n=11), dysplasia (n=7), or nonspecific/normal (n=5) in 49 patients aged [le]13 (28M, 21F). Mean age was 9.1 yr (1.25 - 13.9). Mean age at seizure onset was 3.1 yr (0 - 10). Forty-one anterior temporal lobectomies (9 tailored) and 8 selective amygdalohippocampectomies (SAH) were performed (28 left, 21 right). Twenty-nine (59.2%) patients underwent invasive monitoring. Operative complications included extra-axial hematomas (2), CSF leaks (2), and hydrocephalus (1), all in children with invasive recording. Mean follow-up was 26.4 months (5 - 74) overall and 23.9 (6 - 74) months for the Engel class 1 subgroup. Engel class 1 outcomes occurred at last follow-up in the following: 30/49 (61.2%) children overall; 20/26 (76.9%) with confirmed MTS; 4/11 (36.4%) with gliosis, and 4 of 7 (57%) with dysplasia. All patients undergoing SAH had confirmed MTS and Engel class 1 outcomes. Patients with more than one seizure type had significantly worse outcome (Pearson[apos]s Chi-square, p = 0.025). Of the 26 patients with confirmed MTS, preoperative MRI diagnosed only 12 (46%) with MTS. MRI may not be as sensitive in detecting MTS in children. Selective procedures such as SAH may provide excellent outcomes in carefully selected children. Younger children with TLE have satisfying surgical outcomes, particularly when MTS is present. The only negative predictor identified was multiple seizure types.