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Updated: Jun 27, 2025
Author Spotlight: Studying Clinical Characters and Epilepsy Outcomes After Frontal Disconnection in Patients with MOGHE
Published on: August 16, 2024
Surgical outcomes in children with drug-resistant epilepsy and hippocampal sclerosis
Ream Alashjaie1, Elizabeth N Kerr2, Azhar AlShoumer3
1Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Pediatric epilepsy surgery for hippocampal sclerosis (HS) shows favorable seizure outcomes, even with additional temporal lobe abnormalities. Neurocognitive improvements were observed post-surgery in children with drug-resistant epilepsy.
Area of Science:
- Pediatric Neurology
- Epileptology
- Neurosurgery
Background:
- Hippocampal sclerosis (HS) is a frequent cause of epilepsy in adults undergoing surgery.
- Its prevalence and characteristics in pediatric epilepsy cohorts are less consistently reported.
- Understanding HS in children is crucial for effective treatment strategies.
Purpose of the Study:
- To investigate the epilepsy phenotype, radiological and pathological features, and seizure and neurocognitive outcomes in pediatric patients with drug-resistant epilepsy and HS.
- To analyze outcomes in cases with and without additional subtle signal changes in the anterior temporal lobe.
Main Methods:
- Retrospective analysis of children with drug-resistant focal epilepsy and HS who underwent anterior temporal lobectomy with amygdalohippocampectomy.
- Review of clinical, EEG, neuropsychological, radiological, and pathological data.
- Comparison of outcomes based on the presence of isolated HS versus HS with additional temporal lobe signal changes.
Main Results:
- Thirty-six children were included; 61.1% had isolated HS, and 38.9% had additional subtle signal changes.
- Seizure freedom (ILAE class 1) was achieved in 77.8% of patients after a mean follow-up of 2.3 years.
- Patients with additional pathological abnormalities showed similar seizure freedom rates (63.6%) compared to those with isolated HS/gliosis (84%).
- Significant improvements in auditory and visual memory were noted individually post-surgery.
Conclusions:
- Favorable seizure outcomes are common in pediatric patients with radiological HS, including those with additional pathological findings.
- Surgery can lead to significant neurocognitive improvements in memory tasks.
- Further research into HS subtypes and their impact on outcomes is warranted.
Background:
Hippocampal sclerosis (HS) is a common surgical substrate in adult epilepsy surgery cohorts but variably reported in various pediatric cohorts.
Objective:
We aimed to study the epilepsy phenotype, radiological and pathological variability, seizure and neurocognitive outcomes in children with drug-resistant epilepsy and hippocampal sclerosis (HS) with or without additional subtle signal changes in anterior temporal lobe who underwent surgery.
Methods:
This retrospective study enrolled children with drug-resistant focal epilepsy and hippocampal sclerosis with or without additional subtle T2-Fluid Attenuated Inversion Recovery (FLAR)/Proton Density (PD) signal changes in anterior temporal lobe who underwent anterior temporal lobectomy with amygdalohippocampectomy. Their clinical, EEG, neuropsychological, radiological and pathological data were reviewed and summarized.
Results:
Thirty-six eligible patients were identified. The mean age at seizure onset was 3.7 years; 25% had daily seizures at time of surgery. Isolated HS was noted in 22 (61.1%) cases and additional subtle signal changes in ipsilateral temporal lobe in 14 (38.9%) cases. Compared to the normative population, the group mean performance in intellectual functioning and most auditory and visual memory tasks were significantly lower than the normative sample. The mean age at surgery was 12.3 years; 22 patients (61.1%) had left hemispheric surgeries. ILAE class 1 outcomes was seen in 28 (77.8%) patients after a mean follow up duration of 2.3 years. Hippocampal sclerosis was noted pathologically in 32 (88.9%) cases; type 2 (54.5%) was predominant subtype where further classification was possible. Additional pathological abnormalities were seen in 11 cases (30.6%); these had had similar rates of seizure freedom as compared to children with isolated hippocampal sclerosis/gliosis (63.6% vs 84%, p=0.21). Significant reliable changes were observed across auditory and visual memory tasks at an individual level post surgery.
Conclusions:
Favourable seizure outcomes were seen in most children with isolated radiological hippocampal sclerosis. Patients with additional pathological abnormalities had similar rates of seizure freedom as compared to children with isolated hippocampal sclerosis/gliosis.
