Temporal Lobe Surgery in Pediatric Patients: From Temporal Lobe Epilepsy to Temporal Plus Epilepsy

Abstract

Purpose: Temporal lobe resection can be categorized as either temporal lobe epilepsy (TLE), which involves cortical resection confined to the temporal lobe, or temporal plus epilepsy (TPE), which entails temporal resection along with involvement of additional extratemporal regions. We compared these forms within a pediatric population.

Methods: We identified 136 patients who underwent temporal resection over a 17-year period and investigated the differences in the clinical profiles and seizure outcomes between TLE and TPE.

Results: Of the total sample, 110 patients (80.9%) presented with TLE and 26 (19.1%) with TPE. Significant differences were observed between the groups in age at seizure onset (TLE: 6.3 years, TPE: 0.9 years; P=0.001), age at epilepsy surgery (TLE: 14.2 years, TPE: 9.2 years; P=0.002), the proportion of patients with a history of infantile epileptic spasm syndrome (IESS) (TLE: 6 [5.5%], TPE: 8 [30.3%]; P<0.001), electroclinical presentation with IESS or Lennox-Gastaut syndrome (LGS) (TLE: 11 [10.0%], TPE: 13 [50.0%]; P<0.001), the presence of focal temporal hypometabolism on positron emission tomography (TLE: 74 [68.5%], TPE: 11 [44.0%], P=0.021), and the use of intracranial electroencephalogram monitoring (TLE: 58 [52.7%], TPE: 21 [80.8%]; P=0.009). Furthermore, multivariate analysis identified the epileptic presentation of IESS or LGS as a significant predictor of TPE (P=0.049). The rates of seizure outcomes of International League Against Epilepsy class 1-3 at 1 year of follow-up were 83.8% for the entire cohort, 89.1% for TLE, and 61.5% for TPE (P=0.002).

Conclusion: TPE appears to represent a substantial subset of pediatric temporal resections. The variation in seizure outcomes between groups underscores the importance of predicting TPE in advance, with implications for effective treatment planning.