Abstracts

RATIONALE: Temporal resection for drug resistant epilepsy has traditionally been seen to be an adult procedure, with hippocampal sclerosis the predominant pathology. The aim of this study was to review the range of presentation and responsible pathology in children with drug resistant temporal lobe epilepsy, and relate these parameters to outcome from surgery.
METHODS: Clinical and pathological data were reviewed of 59 children who have undergone temporal lobe resection for drug resistant temporal lobe epilepsy at Great Ormond Street Hospital for children NHS Trust and have been followed for at least 2 years.
RESULTS: For the group as a whole mean age at surgery was 10.6 years (1-18 years). The pathology responsible was hippocampal sclerosis (HS) in 30 (51%), foreign tissue lesion (FTL) in 26 (44%)and 3 other pathologies (one each Rasmussens, Sturge Weber and ischaemic lesion). There was no difference between those with HS and FTL with regard to age of first seizure, age at surgery or the number with specific or moderate learning difficulties (87% vs 80%). However, the FTL group showed a higher frequency of seizures and rate of behaviour disturbance.
At two year follow up in all 59, 34(57%) were seizure free, 12(21%) [gt]75% improved and 13(22%) as presurgery. Of 27 who had 5 year follow up 16(59%) were seizure free, 2 were [gt]75% improved and 4 no change. At two years seizure freedom was seen in 16(53%) of the HS group compared to 18(69%) of the FTL group. In both groups improvements were seen postoperatively in neuropsychological and/or behavioural parameters in 50%.
CONCLUSIONS: The range of clinical features in children presenting for temporal lobe surgery is wide; hippocampal sclerosis remains a significant lesion as seen in adults. Worthwhile benefit is seen in the majority, with postoperative improvement seen in additional parameters to seizure frequency.