Temporal lobectomy in early childhood: The need for long-term follow-up

We retrospectively identified 15 children ages 12 years and under with anti convulsant resistant epilepsy who underwent a temporal lobectomy at Childre n's Hospital, Boston, between 1978 and 1993. Our aim was to study the long- term seizure outcome. Data pertaining to preoperative evaluation, electroen cephalography (EEG), neuroimaging, surgery, seizure outcome, and postoperat ive complications were reviewed. Only patients followed for more than 12 mo nths were included. The average duration of follow-up was 57 months. At the last visit, 47% (7 of 15) of the children were seizure free or only had au ras; another 33% (5 of 15) had > 90% reduction in seizure frequency. Three patients had < 90% seizure reduction. Four cases were initially seizure fre e but had subsequent recurrence between 11 and 28 months after the epilepsy surgery. Factors associated with a good outcome include exclusively focal EEG discharges or an imaging suggestive of a low-grade tumor; factors assoc iated with a poor outcome include generalized EEG discharges and a normal m agnetic resonance image. Temporal lobectomy is useful in the treatment of e arly childhood drug-resistant partial epilepsy, but long-term follow-up is necessary as late seizure recurrence may occur tip to 28 months after surge ry.