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Dysplasia

A common finding in intractable pediatric temporal lobe epilepsy

From the Pediatric Regional Epilepsy Program (Drs. Porter, Clancy, and Dlugos), Children’s Hospital of Philadelphia, and Departments of Pediatrics and Neurology (Drs. Porter, Clancy, and Dlugos), Neurosurgery (Dr. Duhaime), and Pathology (Drs. Judkins and Golden), University of Pennsylvania School of Medicine, Philadelphia.

Address correspondence and reprint requests to Dr. B.E. Porter, Division of Child Neurology, Children’s Hospital of Philadelphia, Wood Bldg., 6th fl., Philadelphia, PA 19104; e-mail: Porterb{at}email.chop.edu

Background: Risk factors for temporal lobe epilepsy (TLE) include history of CNS infection, family history of epilepsy, and history of febrile convulsions (FC). Pre-existing cortical dysplasia (CD) may also predispose to refractory TLE, independent of other risk factors for epilepsy.

Methods: The authors reviewed the neuropathologic features of surgical tissue from temporal lobectomies of 33 pediatric patients with refractory TLE, with and without a history of epilepsy risk factors.

Results: CD was found in 64% (21/33) of all patients with refractory TLE, including 73% (11/15) patients with a history of FC, 66% (2/3) patients with CNS infections, and 83% (5/6) patients with a family history of epilepsy. Disrupted cortical lamination, dystrophic and maloriented neurons, and balloon cells characterized the CD found in the temporal neocortex.

Conclusion: CD was seen in 21 of 33 surgical specimens from children with refractory TLE, including those with and without other epilepsy risk factors.

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