Presurgical evaluation and surgical outcome of temporal lobe epilepsy

Pediatr Neurol. 1999 Mar;20(3):179-84. doi: 10.1016/s0887-8994(98)00128-3.


The authors analyzed 22 patients younger than 18 years of age with temporal lobe epilepsy (TLE) treated surgically. Patients underwent a comprehensive presurgical evaluation, including video-electroencephalogram. Fifty-five percent had a history of febrile seizures. Eighty-two percent had auraes and most exhibited oroalimentary and gestural automatisms. Contralateral dystonic posturing was present in 36% and postictal dysphasia in 54% of patients with left-sided resections. Cranial magnetic resonance imaging (MRI) was abnormal in 59% of patients. MRI revealed changes consistent with mesial temporal sclerosis in 8 (47%) of 17 patients without lesions. Fluorodeoxyglucose-positron emission tomography (PET) scans revealed ipsilateral temporal hypometabolism (PET-TH) in 12 (85.7%) of 14 patients. The intracarotid amobarbital procedure revealed impaired memory of the epileptogenic side in 59% of patients. Seventeen patients underwent en-bloc resections and five lesionectomies and resection of the epileptogenic area. There was no surgical morbidity or mortality. Forty-three percent had hippocampal sclerosis, 28.5% gliosis, 14% low-grade tumors, 9.5% cavernous angiomas, and 5% had no pathologic findings. Follow-up (6 months to 12 years) was available for 21 patients; 76% became seizure free, 19% had rare seizures, and 5% had a worthwhile improvement. TLE can be safely treated surgically in younger patients with excellent results. The clinical manifestations were similar to adult patients. PET-TH was present even at a younger age, suggesting that the focal functional deficits appear early in patients with medically refractory TLE, which may help in the early identification of these patients.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Amobarbital
  • Brain Diseases / complications
  • Brain Diseases / diagnosis*
  • Brain Diseases / surgery
  • Brain Neoplasms / complications
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / surgery
  • Child
  • Electroencephalography
  • Epilepsy, Temporal Lobe / classification
  • Epilepsy, Temporal Lobe / diagnosis*
  • Epilepsy, Temporal Lobe / surgery*
  • Female
  • Follow-Up Studies
  • Hippocampus / pathology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Neuropsychological Tests
  • Psychosurgery
  • Sclerosis / complications
  • Seizures, Febrile / etiology
  • Tomography, Emission-Computed
  • Tomography, Emission-Computed, Single-Photon
  • Treatment Outcome


  • Amobarbital