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Temporal lobectomy in early childhood: the need for long-term follow-up
M A Sotero de Menezes1, M Connolly, A Bolanos
1Department of Neurology, Children's Hospital and Regional Medical Center, University of Washington, Seattle 98105, USA. msoter@chmc.org
Insights
Temporal lobectomy can be effective for drug-resistant childhood epilepsy, with many achieving seizure freedom or significant reduction. However, long-term follow-up is crucial due to potential late seizure recurrence.
Area of Science:
- Pediatric Neurology
- Neurosurgery
Background:
- Anticonvulsant-resistant epilepsy in children presents significant treatment challenges.
- Temporal lobectomy is a surgical option for refractory epilepsy.
Purpose of the Study:
- To evaluate the long-term seizure outcomes of temporal lobectomy in children with drug-resistant epilepsy.
- To identify factors associated with successful surgical outcomes and late recurrence.
Main Methods:
- Retrospective review of 15 children (≤12 years) who underwent temporal lobectomy (1978-1993).
- Analysis of preoperative data, electroencephalography (EEG), neuroimaging, surgical details, and seizure outcomes.
- Inclusion criteria required >12 months of follow-up.
Main Results:
- 47% of children were seizure-free or had only auras at last follow-up (average 57 months).
- 33% experienced >90% reduction in seizure frequency.
- Late seizure recurrence occurred in 4 patients between 11-28 months post-surgery.
- Favorable outcomes linked to focal EEG and tumor-suggestive imaging; poor outcomes to generalized EEG and normal MRI.
Conclusions:
- Temporal lobectomy is a valuable treatment for drug-resistant partial epilepsy in early childhood.
- Long-term monitoring is essential due to the possibility of late seizure recurrence after epilepsy surgery.
Abstract:
We retrospectively identified 15 children ages 12 years and under with anticonvulsant resistant epilepsy who underwent a temporal lobectomy at Children's Hospital, Boston, between 1978 and 1993. Our aim was to study the long-term seizure outcome. Data pertaining to preoperative evaluation, electroencephalography (EEG), neuroimaging, surgery, seizure outcome, and postoperative complications were reviewed. Only patients followed for more than 12 months 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 auras: another 33% (5 of 15) had > 90% reduction in seizure frequency. Three patients had < 90% seizure reduction. Four cases were initially seizure free 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 associated with a poor outcome include generalized EEG discharges and a normal magnetic resonance image. Temporal lobectomy is useful in the treatment of early childhood drug-resistant partial epilepsy, but long-term follow-up is necessary as late seizure recurrence may occur up to 28 months after surgery.