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Published on: December 18, 2016
Temporal lobe epilepsy in children: electroclinical study of 77 cases
Elena Fontana1, Francesca Negrini, Stefano Francione
1Unit of Child Neuropsychiatry, University of Verona, Verona, Italy.
Insights
Recognizing temporal lobe epilepsy (TLE) in children is challenging due to varied symptoms. Early diagnosis of pediatric TLE relies on electroclinical and neuroradiological assessments, even for early-onset cases.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neuroscience
Background:
- Temporal lobe epilepsy (TLE) presents unique diagnostic challenges in children compared to adults.
- Pediatric TLE exhibits less stereotyped ictal symptoms and greater neuropathological heterogeneity.
- Early recognition is crucial for effective management of pediatric TLE.
Purpose of the Study:
- To investigate the interplay between etiology, age at onset, and electroclinical findings in pediatric TLE.
- To analyze data from 77 children with TLE, including 32 who underwent surgery.
- To identify patterns aiding in the early diagnosis of TLE in children.
Main Methods:
- Electroclinical evaluation of 77 children diagnosed with TLE.
- Video-electroencephalography (EEG) recording of seizures to analyze initial ictal symptoms.
- Correlation of clinical presentation with EEG findings and neuroradiological data.
Main Results:
- Age at onset varied, with 39 cases under 3 years, 17 between 3-6 years, and 21 over 6 years.
- Auras were less frequent in younger children but increased after age 6.
- Distinct ictal semiologies, including staring and cyanosis, were observed; some cases showed independent bilateral temporal lobe seizure onset.
- Three subgroups were identified: symptomatic TLE (malformations/tumors), mesial temporal sclerosis, and cryptogenic TLE.
Conclusions:
- A comprehensive electroclinical and neuroradiological approach facilitates early TLE recognition in children, even with onset before age 6.
- Video-EEG is primary for seizure localization, with repeat recordings beneficial for cases lacking clear neuroradiological correlation.
- Accurate diagnosis improves management strategies for pediatric temporal lobe epilepsy.
Purpose:
Temporal lobe epilepsy (TLE) is probably more difficult to recognize in children than in adults. In fact, ictal symptoms in children are less stereotyped and less obvious, and the neuropathological substrate is more heterogeneous than in adults. The aim of this study is to examine the relationships between etiology, age at onset and electroclinical findings in 77 children with TLE, 32 of whom were surgically treated.
Methods:
Electroclinical study including video-EEG recording of seizures in 77 children with TLE. The investigation focused on the first five initial ictal symptoms.
Results:
Age at onset was less than 3 years in 39 cases, between 3 and 6 years in 17 cases and older than 6 years in 21 cases. Auras also occurred in younger children but were more common after the age of 6 years. A peculiar initial ictal semiology consisted in staring with arrest, lip cyanosis, and very slight oral automatisms. In some cases, EEG recordings documented seizures starting independently on both temporal lobes. Based on electroclinical and neuroradiological features, we recognized three subgroups: symptomatic TLE due to cortical malformations or nonevolutive tumors, TLE with mesial temporal sclerosis, and cryptogenic TLE.
Conclusions:
A correct electroclinical and neuroradiological approach allows in several cases early recognition of TLE even when onset is earlier than the age of 6 years. A correct definition of the localization relies primarily on video-EEG recording of the seizures, possibly repeated during follow up in cases lacking obvious neuroradiological correlation.
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