Temporal lobe epilepsy surgery in children and adults: A multicenter study

Area of Science:

• Neurology
• Pediatric Neurology
• Neurosurgery

Background:

• Temporal lobe epilepsy (TLE) is a common form of focal epilepsy, often requiring surgical intervention.
• Surgical outcomes in TLE can vary significantly based on patient age and other clinical factors.
• Understanding age-specific outcomes and predictors is crucial for optimizing TLE treatment strategies.

Purpose of the Study:

• To compare seizure and cognitive outcomes between children and adults undergoing TLE surgery.
• To identify predictors of surgical success in pediatric and adult TLE patients.
• To evaluate the impact of age on long-term seizure control and medication discontinuation after TLE surgery.

Main Methods:

• A retrospective multicenter study analyzed data from 511 patients (114 children) who underwent TLE surgery.
• Descriptive analysis and multivariable mixed-effect models were employed.
• Outcomes assessed included seizure control (Engel class) and antiepileptic drug (AED) discontinuation at last follow-up.

Main Results:

• Children had a significantly higher likelihood of achieving Engel class IA outcome and discontinuing AEDs post-surgery compared to adults.
• While overall Engel class I rates at last follow-up did not differ significantly between age groups, predictors of seizure outcome varied.
• Postoperative EEG in adults and complete resection of non-hippocampal sclerosis temporal MRI abnormalities in children were key predictors of seizure freedom.

Conclusions:

• Significant clinical differences between pediatric and adult TLE patients undergoing surgery correlate with distinct long-term outcomes and failure predictors.
• Children demonstrate a greater propensity for sustained seizure freedom and AED withdrawal following TLE surgery.
• Encouraging earlier referral for TLE surgery in children may lead to improved long-term surgical outcomes.