Temporal Lobe Epilepsy After Prolonged Febrile Convulsions: Excellent Outcome After Surgical Treatment

Abstract

We studied 47 consecutive patients who underwent temporal resection for seizure control. Nineteen (40%) had febrile convulsions preceding onset of their habitual seizures. In 17 of 18 patients whose disease duration was known, the febrile convulsions were prolonged (mean 4 h). As compared with patients without preceding febrile convulsions, patients with antecedent febrile convulsions had a significantly higher prevalence of positive family history of febrile convulsions, an increased incidence of retrospectively identified gestational or perinatal complications, and no foreign tissue lesions. Pathologic studies showed gliosis and cell loss in mesiotemporal structures, usually moderate, in addition to usually mild gliosis in lateral temporal cortex. These patients had an excellent outcome after temporal resection: 84% were seizure-free, had residual auras only, or occasional convulsions with medication discontinuation. One patient (5%) had > 90% improvement. Two patients (11%) in whom the hippocampus was totally spared continued to have complex partial seizures: in both, seizures stopped after reoperation and hippocampal resection. Thus, 95% of these patients had an excellent result. Only 16% required invasive preoperative studies to confirm lateralization. These results were significantly better than those of the group without preceding febrile convulsions (p = 0.0013).

Factors Predictive of the Outcome of Frontal Lobe Epilepsy Surgery

“…None of the five patients with a history of febrile seizure had an excellent outcome after FLES. The association between childhood febrile seizures and mesial temporal sclerosis is well known (25,26). Twenty-five to thirty percent of temporal lobe epilepsy surgery patients have a history of childhood febrile seizures (2,27) compared with 5% of extratemporal epilepsy surgery patients (27).…”

Morphometric Analysis of the Temporal Lobe in Temporal Lobe Epilepsy

“…Because a favorable response to unilateral temporal lobe resection is observed in >75% of patients (1,2), much attention has been paid to the correct lateralization of the epileptogenic hippocampus. Predominantly unilateral abnormalities of the hippocampus can now be identified by visual inspection of magnetic resonance imaging (MRI) scans (3-6) or by MR relaxometry or volumetry (7-1 1) in 70-90% of patients with TLE.…”

“…Hardiman et al (12) observed microdysgenesis in the temporal neocortex in a greater proportion of patients with TLE than in controls, suggesting that neuronal migration to the neocortex is abnormal in TLE. Histological abnormalities such as subpial and subcortical gliosis are often detected in the neocortex of patients with intractable TLE undergoing surgical resection (1,13). On MRI scans, increased neocortical T, signal, ipsilateral atrophy of temporal lobe collateral white matter, and decreased gray/white matter demarcation may volume of the temporal lobe and in the volume of gray matter.…”

Linkage study of voltage-gated potassium channels in familial mesial temporal lobe epilepsy

“…Hippocampal atrophy (HA) and increased T2 signal in limbic structures are a frequent MRI finding related with mesial temporal sclerosis (MTS) identified in patients with mesial temporal lobe epilepsy (MTLE) [10][11] . MTLE is the most common partial epilepsy in adults and it is frequently associated with an early-life initial insult, such as a childhood prolonged febrile seizure [12][13][14] . We were the first to identify a type of MTLE with clear evident of familial recurrence (FMTLE) [15][16][17] .…”