Temporal lobectomy for complex partial seizures that began in childhood

Area of Science:

• Neurology
• Neurosurgery
• Epileptology

Background:

• Intractable temporal lobe epilepsy (TLE) in children often necessitates surgical intervention.
• Presurgical evaluation typically involves invasive monitoring, carrying risks and costs.
• Optimizing patient selection for TLE surgery is crucial for favorable outcomes.

Purpose of the Study:

• To evaluate the efficacy of temporal resection for childhood-onset intractable TLE without invasive preoperative monitoring.
• To compare outcomes with series utilizing invasive monitoring.
• To assess the impact of epilepsy duration on surgical outcomes in patients with neoplasia.

Main Methods:

• Retrospective analysis of 46 consecutive pediatric patients undergoing temporal resection for intractable TLE.
• Patient selection was based on non-invasive methods, including long-term electroencephalographic monitoring in later cases.
• Surgical outcomes were assessed based on seizure control and behavioral improvements.

Main Results:

• 85% of patients achieved seizure freedom or near-total seizure control.
• Outcomes were comparable to those reported in series using invasive monitoring.
• Patients with neoplasia and longer epilepsy duration had less favorable outcomes.

Conclusions:

• Temporal resection can be successfully performed for intractable TLE in children without invasive presurgical monitoring.
• Non-invasive selection methods are effective, reducing patient risk and healthcare costs.
• Early surgical intervention is recommended for children with intractable epilepsy, particularly those without neoplasia.