Maton Bruno, Jayakar Prasanna, Resnick Trevor, Morrison Glenn, Ragheb John, Duchowny Michael
The Brain Institute, Miami Children's Hospital, Miami, Florida, USA.
Epilepsia. 2008 Jan;49(1):80-7. doi: 10.1111/j.1528-1167.2007.01315.x. Epub 2007 Sep 12.
Temporal lobe epilepsy (TLE) in early life is often a catastrophic disorder with pharmacoresistant seizures and secondary neurological deterioration. there is little data available regarding epilepsy surgery performed in infants and young children and no prior study has focused on tle.
We analyzed the results of temporal resection for epilepsy as the primary indication in children less than age 5 years who had at least 2 years of follow-up.
20 children (14 males) were identified with a mean age at surgery of 26 months and a mean age at seizure onset of 12 months. Clinical presentation was diverse. Typical psychomotor seizures (n = 4; mean age at surgery 37 months) were followed by prominent motor changes (n = 7; 30 months) and were occasionally isolated (n = 3; 23 months). Epileptic spasms were noted in six patients and were frequently associated with lateralizing features. The interictal EEG was lateralizing in 15 patients and the ictal EEG was lateralizing in 18 patients. Brain MRI provided localizing value in 16 patients, ictal SPECT was concordant in 4/8 cases. Invasive EEG was employed in six cases. At mean follow-up of 5.5 years, 65% of the children were seizure-free and 15% had >90% seizure reduction. Morbidity included infection and hydrocephalus in one case and stroke-related hemiparesis in two cases. Cortical dysplasia was identified in eight children, tumors in eight including two DNET, two ganglioglioma, and four malignant tumors. Hippocampal sclerosis was present in four cases, always as dual pathology.
TLE presents in early life with varied and severe manifestations. Excisional procedures in this age group are associated with favorable seizure reduction similar to older children and in adults.
早期颞叶癫痫（TLE）通常是一种灾难性疾病，伴有药物难治性癫痫发作和继发性神经功能恶化。关于婴幼儿癫痫手术的数据很少，且之前没有研究聚焦于TLE。
我们分析了以癫痫为主要指征的颞叶切除术在5岁以下且至少随访2年的儿童中的结果。
确定了20名儿童（14名男性），手术时平均年龄为26个月，癫痫发作起始平均年龄为12个月。临床表现多样。典型的精神运动性癫痫发作（n = 4；手术时平均年龄37个月）之后是明显的运动改变（n = 7；30个月），偶尔也有孤立发作（n = 3；23个月）。6名患者出现癫痫性痉挛，且常伴有定位特征。发作间期脑电图在15名患者中具有定位意义，发作期脑电图在18名患者中具有定位意义。脑部MRI在16名患者中提供了定位价值，发作期单光子发射计算机断层扫描（SPECT）在4/8例中结果一致。6例患者采用了侵入性脑电图检查。平均随访5.5年时，65%的儿童无癫痫发作，15%的儿童癫痫发作减少>90%。并发症包括1例感染和脑积水，2例与中风相关的偏瘫。8名儿童发现有皮质发育异常，8名有肿瘤，包括2例胚胎发育不良性神经上皮肿瘤（DNET）、2例神经节细胞胶质瘤和4例恶性肿瘤。4例存在海马硬化，均为双重病理改变。
TLE在早期表现多样且严重。该年龄组的切除手术与较大儿童及成人相似，在减少癫痫发作方面效果良好。
