New-onset temporal lobe epilepsy in children

Abstract

Objective: To determine factors predictive of long-term seizure outcome in children with new-onset temporal lobe epilepsy (TLE). Methods: A community-based cohort of 77 children with new-onset TLE, including 14 with possible TLE, were followed prospectively with formal review 7 and 14 years following seizure onset. Diagnoses were re-evaluated at each review, and changed when new clinical, EEG, or imaging data were compelling. Results: Sixty-four patients sustained the diagnosis of TLE over time; two were lost to follow-up. Age at follow-up was 12 to 29 years (median 20 years). Median follow-up was 13.7 years, 95% being followed for greater than 10 years. Nineteen patients were seizure free (SF) and off treatment, having not had seizures for 5 to 15 years. Duration of active TLE in the SF group was 1 to 8 years, the children being treated with 0 to 3 antiepileptic drugs (AEDs). Forty-three patients were not seizure free (NSF) and had ongoing seizures or had undergone epilepsy surgery. These children were treated with 1 to 10 AEDs. Fifteen NSF patients experienced 22 nonterminal seizure remissions of 1 to 7 years duration. Seventeen children had a significant antecedent to TLE. Lesions were identified on neuroimaging in 28 and included hippocampal sclerosis (HS) in 10, tumor in 8, and dysplasia in 7. All children with lesions on MRI were NSF (p 0.001). Focal slowing on EEG was also associated with persistent seizures (p 0.05), although this was correlated with a lesion on MRI. Infantile onset of epilepsy, family history of seizures, initial seizure frequency, antecedents, and early seizure remissions were not predictive of seizure outcome. Conclusion: Seizures spontaneously remit in approximately one third of children with new-onset TLE. A lesion on MRI predicts intractable seizures in TLE and the potential need for epilepsy surgery.

Seizures in Children with Brain Tumours — Epidemiology, Significance, Management, and Outcomes

“…In one study reported by Ibrahim et al, for example, the time from seizure onset to tumour diagnosis among ten children presenting with seizures ranged from two weeks to two years, averaging six months [37]. A wide range of opinions and practices exist regarding how aggressive to pursue diagnostic imaging in children presenting with seizures [36,41,51,79,80,100,[127][128][129][130][131][132][133]. For example, in one series of eighteen patients between the ages of 1 month and 13 years who presented with seizures and were discovered to have DNETs between January 1992 and December 2004, the preoperative evaluation included magnetic resonance (MR) imaging and interictal scalp electro-encephalography (EEG) in all patients, but functional MR imaging also was performed in eight patients, video monitoring with scalp EEG during seizures in 12 patients, interictal single-photon emission computerized tomography (SPECT) scanning in one patient, and ictal SPECT scanning in two patients [132].…”

“…Having seizures in the presence of a tumour has implications with respect to management of the seizures as well, in that studies have shown that such seizures tend to be more resistant to AEDs than idiopathic seizures [133,142]. This appears to be especially true for patients who present with a history of numerous seizures [142].…”

Perspectives of epilepsy surgery in resource-poor countries: a study in Georgia

“…There is evidence that patients with any type of focal seizures (structural, metabolic, or of unknown etiology) are more commonly associated with development of pharmacoresistance than patients with generalized seizures [34]. Epileptogenic structural cortical lesions, such as hippocampal sclerosis (HS) and malformations of cortical development (MCD), are considered as major risk factors for PRS [29,30]. Epilepsy surgery aimed at resection of these lesions is often considered a curative treatment for PRE.…”

Structural and Quantitative MRI in Epilepsy

“…Improvements in high-resolution MRI and quantitative post-processing methods now permit detection of structural abnormalities in patients that are not otherwise visually apparent. This is especially important as an MRI-identifi ed lesion is associated both with poorer response to medications (Cardoso et al, 2006 ;Spooner, Berkovic, Mitchell, Wrennall, & Harvey, 2006 ) and with a greater likelihood of seizure freedom following resective surgery (Berkovic et al, 1995 ;Jeha et al, 2007 ).…”