Abstracts

Temporal lobectomy is effective in children with Temporal Lobe Epilepsy (TLE), Wyllie et. al. Ann Neurol 1998. However, Jarrar et.al. Neurology 2002, reported increase seizure recurrence with longer duration of follow-up; their patients underwent surgery before 1983. We wished to study the long term follow-up in patients treated since 1986 when advances in the presurgical evaluation became available This is a prospective study of 28 children and adolescents with refractory TLE treated surgically between 1986-2002 by the same neurosurgeon, following a comprehensive presurgical evaluation including Video-EEG with sphenoidal electrodes. Patients were followed longitudinally at 6 wks, 3, 6, mths and yearly threreafter. Clinical manifestations, pathological diagnosis, complications, and outcome were analyzed. Engel[apos]s seizure classification was used. The age of seizure onset was 1 yr-13 yrs, age at surgery 8-17 yrs, and duration of epilepsy 3 yrs-15 yrs. 53% had history of febrile seizures, 68% had abnormal head MRIs, and 94% had ipsilateral PET hypometabolism. All had unitemporal seizures recorded on prolonged Video-EEG (11% required invasive recordings). The intracarotid amobarbital procedure showed that the contralateral hemisphere was able to support memory. All underwent temporal resections under general anesthesia; one had re-operation. There was no surgical mortality or morbidity. 54% had mesial temporal sclerosis, 21% gliosis, 7% cavernous angiomas, 14% low grade tumors, and 3.5% had no pathologic diagnosis. 78.5% became seizure free, 7% had rare seizures, and 4% had worthwhile seizure reduction, ( follow-up 2 yrs to 18 yrs; mean = 9 years) Our study showed that the long term outcome of children and adolescents with temporal lobe epilepsy treated since 1986 when MRI, PET and other advances in the presurgical and surgical evaluation became available remains favorable, with no surgical mortality or morbidity