Presurgical evaluation and surgical outcome of temporal lobe epilepsy

The authors analyzed 22 patients younger than 18 years of age with temporal lobe epilepsy (TLE) treated surgically. Patients underwent a comprehensive presurgical evaluation, including video-electroencephalogram. Fifty-five p ercent had a history of febrile seizures. Eighty-two percent had auraes and most exhibited oroalimentary and gestural automatisms. Contralateral dysto nic posturing was present in 36% and postictal dysphasia in 54% of patients with left-sided resections. Cranial magnetic resonance imaging (MRI) was a bnormal in 59% of patients. MRI revealed changes consistent with mesial tem poral sclerosis in 8 (47%) of 17 patients without lesions. Fluorodeoxygluco se-positron emission tomography (PET) scans revealed ipsilateral temporal h ypometabolism (PET-TH) in 12 (85.7%) of 14 patients. The intracarotid amoba rbital procedure revealed impaired memory of the epileptogenic side in 59% of patients. Seventeen patients underwent en-bloc resections and five lesio nectomies and resection of the epileptogenic area, There was no surgical mo rbidity or mortality. Forty-three percent had hippocampal sclerosis, 28.5% gliosis, 14% low-grade tumors, 9.5% cavernous angiomas, and 5% had no patho logic findings. Follow-up (6 months to 12 years) was available for 21 patie nts; 76% became seizure free, 19% had rare seizures, and 5% had a worthwhil e improvement. TLE can be safely treated surgically in younger patients wit h excellent results. The clinical manifestations were similar to adult pati ents. PET-TH was present even at a younger age, suggesting that the focal f unctional deficits appear early in patients with medically refractory TLE, which may help in the early identification of these patients. (C) 1999 by E lsevier Science Inc. All rights reserved.