TEMPORAL-LOBE EPILEPSY IN CHILDHOOD - CLINICAL, EEG, AND NEUROIMAGINGFINDINGS AND SYNDROME CLASSIFICATION IN A COHORT WITH NEW-ONSET SEIZURES

Sixty-three children with new-onset temporal lobe epilepsy (TLE) under went extensive clinical, EEG, and neuroimaging investigation as part o f a prospective, community-based cohort study of the natural history o f TLE in childhood. Complex partial seizures occurred in 94% of the ch ildren, and tonic-clonic seizures occurred in 14%. Developmental, beha vioral, or learning problems were present in 38%. Eighteen children (2 9%) had a significant illness/event prior to the onset of TLE, includi ng febrile status epilepticus in seven, meningitis in four, respirator y arrest in two, and head injury in one. Magnetic resonance imaging or computed tomography revealed structural abnormalities of the temporal lobe in 24 children (38%), including hippocampal sclerosis (HS) in 13 and tumor in eight. There was a strong association between HS and a h istory of significant illness/event prior to the onset of TLE (p < 0.0 01). Analysis of past history and neuroimaging findings led us to prop ose three etiologically defined subgroups of TLE; developmental TLE (1 0 children with long-standing, nonprogressive temporal lobe tumors and malformations), TLE with HS/significant antecedents (18 children with HS or a history of a significant illness/event), and cryptogenic TLE (34 children with normal neuroimaging findings and no significant past history). Etiologic differences between children with new-onset TLE c onfer prognostic information that will be useful for counselling famil ies and planning treatment.