TEMPORAL-LOBE EPILEPSY IN INFANTS AND CHILDREN

Temporal lobe epilepsy in adults and adolescents is a fairly homogeneo us syndrome, both in terms of seizure semiology and in terms of its pa thology, and it has been studied extensively. Temporal lobe epilepsy i n infants and young children has begun to receive increasing attention in recent years, and a different clinico-pathological picture has eme rged. Clinically, the concept of complex partial seizures, which may b e useful in adults, is difficult to apply to infants, since it is ofte n not possible to assess impairment of consciousness in this age group . The main distinctive features of complex partial seizures of tempora l lobe origin in infants are (1) a predominance of behavioral arrest w ith possible impairment of consciousness, (2) no identifiable aura, (3 ) automatisms that are discrete and mostly orofacial, (4) more promine nt convulsive activity, and (5) a longer duration (more than 1 min). I n addition, seizures of temporal lobe origin in infants may appear cli nically generalized, such as infantile spasms or generalized tonic sei zures, or can occasionally represent a benign syndrome. The neuropatho logical findings of temporal lobe epilepsy in infants differ even more than the clinical seizure semiology. In contrast to adult and adolesc ent patients, mesial temporal sclerosis is a rare finding in infants, in whom the pathological abnormalities associated with seizures of tem poral lobe origin consist mostly of dysplasias, migrational disorders, hamartomas, and low-grade tumors such as gangliogliomas. Mesial tempo ral sclerosis is seen more often in older children than in infants, an d its pathogenesis remains a subject of controversy. (C) 1998 Elsevier Science B.V.