[Three infantile cases of temporal lobe epilepsy presenting as apnea]

We describe three cases of temporal lobe epilepsy in infancy presenting as repeated apneic attacks. In all cases, ictal electroencephalogram (EEG) showed unilateral focal high-voltage slow waves over the temporal or frontal areas. In two of the three cases, the epilepsy was due to mesial temporal tumors, and the apneic attacks disappeared following the removal of the tumor. Pathological examination identified ganglioglioma in both cases. In the remaining case, no focal lesions were found despite ictal EEG evidence of focal temporal abnormalities. Although intractable to several anti-convulsants, the addition of acetazolamide was dramatically effective in ceasing the apneic attacks. When assessing infants with apneic attacks, although causes such as obstructive apnea and gastroesophageal reflux need to be excluded, a diagnosis of epilepsy also needs to be considered as an important cause of apparent life-threatening events (ALTE). We would recommend EEG with video monitoring during apneic attacks in such cases.