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Abstract

Objective: To characterize the pathologic findings of temporal lobe epilepsy (TLE) in children undergoing temporal lobectomy for refractory seizures and to correlate these findings with clinical presentation.
Methods: The authors reviewed the charts of all children who underwent anterior temporal lobectomy for refractory TLE from 1979 through 1999. A new neuropathologic analysis was performed blinded to clinical features and outcome.
Results: Twenty-two children met inclusion criteria. Mean age at onset of epilepsy was 3 years, 7 months (range 1 month to 10 years). Mean age at surgery was 10 years, 11 months (range 1 to 18 years). All patients had complex partial seizures, 48% with secondary generalization. Most had daily seizures. Auras were reported in 45% of patients. Post-resection follow-up averaged 5 years, 2 months (range 2 to 19 years). Seizure-free status was achieved in 41% of patients, and 14% had residual auras only. The most frequent neuropathologic abnormalities were cortical dysplasia (CD) of the temporal neocortex (14 of 22) and mesial temporal sclerosis (MTS) (12 of the 15 children with available hippocampal tissue). These two findings coexisted in seven children. MTS was associated with extra-hippocampal pathology in 8 of 12 (67%) of the cases.
Conclusions: MTS occurs frequently in association with CD in this population of children. The high incidence of dual pathology could explain the early age of seizure onset and high seizure frequency rate observed. TLE in childhood may constitute a different entity than in adults, from both the clinical and neuropathologic perspectives.

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References

1.
Engel J Jr, Williamson PD, Wieser HG. Mesial temporal lobe epilepsy. In: Epilepsy: a comprehensive textbook. Philadelphia: Lippincott-Raven Publishers, 1997: 2417–2426.
2.
Bourgeois BFD. Temporal lobe epilepsy in infants and children. Brain Dev . 1998; 20: 135–141.
3.
Babb TL, Brown WJ. Pathologic findings in epilepsy. In: Engel J Jr, ed. Surgical treatment of the epilepsies. New York: Raven Press, 1987:511–540.
4.
Levesque MF, Nakasato N, Vinters HV, Babb TL. Surgical treatment of limbic epilepsy associated with extrahippocampal lesions: the problem of dual pathology. J Neurosurg . 1991; 75: 364–370.
5.
Raymond AA, Fish DR, Sisodiya SM, Alsanjari N, Stevens JM, Shorvon SD. Abnormalities of gyration, heterotopias, tuberous sclerosis, focal cortical dysplasia, microdysgenesis, dysembryoplastic neuroepithelial tumour and dysgenesis of the archicortex in epilepsy: clinical, EEG and neuroimaging features in 100 adult patients. Brain . 1995; 118: 629–660.
6.
Cendes F, Cook MJ, Watson C, et al. Frequency and characteristics of dual pathology in patients with lesional epilepsy. Neurology . 1995; 45: 2058–2064.
7.
Mizrahi EM, Kellaway P, Grossman RG, et al. Anterior temporal lobectomy and medically refractory temporal lobe epilepsy of childhood. Epilepsia . 1990; 31: 302–312.
8.
Duchowny M, Levin B, Jayakar P, et al. Temporal lobectomy in early childhood. Epilepsia . 1992; 33: 298–303.
9.
Adelson PD, Peacock WJ, Chugani HT, et al. Temporal and extended temporal resections for the treatment of intractable seizures in early childhood. Pediatr Neurosurg . 1992; 18: 169–178.
10.
Kuzniecky R, Murro A, King D, et al. Magnetic resonance imaging in childhood intractable partial epilepsies: pathologic correlations. Neurology . 1993; 43: 681–687.
11.
Harvey AS, Berkovic SF, Wrennall JA, Hopkins IJ. Temporal lobe epilepsy in childhood: clinical, EEG, and neuroimaging findings and syndrome classification in a cohort with new-onset seizures. Neurology . 1997; 49: 960–968.
12.
Wyllie E, Comair YG, Kotagal P, et al. Seizure outcome after epilepsy surgery in children and adolescents. Ann Neurol . 1998; 44: 740–748.
13.
Salanova V, Markand O, Worth R, et al. Presurgical evaluation and surgical outcome of temporal lobe epilepsy. Pediatr Neurol . 1999; 20: 179–184.
14.
Jay V, Becker LE, Otsubo H, et al. Pathology of temporal lobectomy for refractory seizures in children. J Neurosurg . 1993; 79: 53–61.
15.
Wyllie E, Chee M, Granstrom ML, et al. Temporal lobe epilepsy in early childhood. Epilepsia . 1993; 34: 859–868.
16.
Mohamed A, Wyllie E, Ruggieri P, et al. Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery. Neurology . 2001; 56: 1643–1649.
17.
Engel J Jr, Van Ness PC, Rasmussen TB, Ojemann LM. Outcome with respect to epileptic seizures. In: Engel J Jr, ed. Surgical treatment of the epilepsies. New York: Raven Press, 1993: 609–621.
18.
Mischel PS, Nguyen LP, Vinters HV. Cerebral cortical dysplasia associated with pediatric epilepsy: review of neuropathologic features and proposal for a grading system. J Neuropathol Exp Neurol . 1995; 54: 137–153.
19.
Kasper BS, Stefan H, Buchfelder M, Paulus W. Temporal lobe microdysgenesis in epilepsy versus control brains. J Neuropathol Exp Neurol . 1999; 58: 22–28.
20.
Taylor DC, Falconer MA, Bruton CJ, et al. Focal dysplasia of the cerebral cortex in epilepsy. J Neurol Neurosurg Psychiatry . 1971; 34: 369–387.
21.
Edwards JC, Wyllie E, Ruggeri PM, et al. Seizure outcome after surgery for epilepsy due to malformations of cortical development. Neurology . 2000; 55: 1110–1114.
22.
Raymond AA, Fish DR, Stevens JM, Cook MJ, Sisodiya SM, Shorvon SD. Association of hippocampal sclerosis with cortical dysgenesis in patients with epilepsy. Neurology . 1994; 44: 1841–1845.
23.
Ho SS, Kuzniecky RI, Gilliam F, et al. Temporal lobe developmental malformations and epilepsy: dual pathology and bilateral hippocampal abnormalities. Neurology . 1998; 50: 748–754.
24.
Cendes F, Li LM, Andermann F, et al. Dual pathology and its clinical relevance. Adv Neurol . 1999; 81: 153–164.
25.
Fernandez G, Effenberger O, Vinz B, et al. Hippocampal malformation as a cause of familial febrile convulsions and subsequent hippocampal sclerosis. Neurology . 1998; 50: 909–917.
26.
Germano IM, Zhang YF, Sperber EF, Moshe SL. Neuronal migration disorders increase susceptibility to hyperthermia-induced seizures in developing rats. Epilepsia . 1996; 37: 902–910.
27.
Li LM, Cendes F, Andermann F, et al. Surgical outcome in patients with epilepsy and dual pathology. Brain . 1999; 122: 799–805.
28.
Fischer RS, Blum D. Epilepsy surgery where there is dual pathology. Lancet . 1999; 354: 267–268.

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Published In

Neurology®
Volume 60Number 2January 28, 2003
Pages: 191-195
PubMed: 12552029

Publication History

Received: March 21, 2002
Accepted: October 8, 2002
Published online: January 28, 2003
Published in print: January 28, 2003

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Authors

Affiliations & Disclosures

C. Bocti, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.
Y. Robitaille, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.
P. Diadori, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.
A. Lortie, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.
C. Mercier, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.
A. Bouthillier, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.
L. Carmant, MD
From the Department of Pediatrics, Neurology Division (Drs. Bocti, Lortie, Diadori, and Carmant), Department of Surgery, Neurosurgery Division (Drs. Bouthillier and Mercier), and Department of Pathology (Dr. Robitaille), Hôpital Ste-Justine, Université de Montréal, Canada.

Notes

Address correspondence and reprint requests to Dr. Lionel Carmant, Department of Pediatrics, Neurology Division, Hôpital Ste-Justine, 3175, Côte Ste-Catherine, Montréal (Québec), H3T 1C5, Canada; e-mail: [email protected]

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