Abstracts

Recent studies have suggested temporal lobe epilepsy (TLE) in children may constitute a different entity compared to TLE in adults, from both the clinical and neuropathologic perspectives. To confirm this hypothesis, a retrospective analysis of temporal lobectomy cases from our institution was performed to characterize the pathological findings, clinical features and surgical outcome in children with medically intractable TEL. Charts of all children who underwent temporal lobectomy for refractory TLE from 1992-2003 were reviewed. Analysis of pathological findings was performed to correlate with clinical features and surgical outcome. Thirty-nine children met inclusion criteria. Mean age of seizure onset was 5 years, 6 months (range 2 months to 14 years). Mean age at surgery was 12 years, 6 months (range 6 to 17 years). All patients had complex partial seizures and majority with secondary generalization. Post-resection follow-up averaged 5 years, 10 months (range 1 to 12 years).
Dual pathology characterized by mesial temporal sclerosis (MTS) with an extra-hipocampal lesion such as cortical dysplasia (CD), amygdale sclerosis (AS) or low grade tumor accounts for 33% (13/39) cases. Isolated MTS accounts for 21% (8/39) cases. Isolated low grade tumor, CD or AS account for 20% (8/39), 15% 6/39) and 10% (4/39) respectively. Total cases of MTS (isolated MTS and dual lesion pathology) occur in 54% (21/39) cases. Total cases of CD with and without MTS occur in 36% (14/39). History of febrile seizures was found in 75 % (6/8) isolated MTS cases, 38% (5/13) dural pathology cases and only 5% (1/21) non-MTS cases. There is no significant difference in age of seizure onset in patients with isolated MTS (4.7 years), dural pathology (5.5 years), and non-MTS (7.3 years). Seizure-free was achieved in 84% of all patient with temporal lobectomy after 1 year follow up. The seizure free rate came down to 76 % and 67% after 3 and 5 year follow up respectively. Our result confirmed that high incidence of dual pathology and CD is the characteristic pathological findings in children with TLE. History of febrile seizures may play a role in MTS. This study demonstrates once again that temporal lobectomy is a safe and potentially curative treatment for children with refractory TLE.