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New-onset temporal lobe epilepsy in children

Lesion on MRI predicts poor seizure outcome

From the Children's Epilepsy Program, Department of Neurology (C.G.S., S.F.B., J.A.W., A.S.H.), Murdoch Children's Research Institute (C.G.S.), Department of Radiology (L.A.M.), and Department of Psychology (J.A.W.), Royal Children's Hospital, Melbourne; Department of Paediatrics (A.S.H.), Department of Radiology (L.A.M.), University of Melbourne; Epilepsy Research Centre, Department of Medicine (S.F.B., A.S.H.), University of Melbourne, Austin Health, Melbourne, Australia; and Department of Neurology (C.G.S.), Starship Children's Hospital, Auckland, New Zealand.

Address correspondence and reprint requests to Dr Harvey, Children's Epilepsy Program, Department of Neurology, Royal Children's Hospital (Melbourne), Flemington Road, Parkville, Victoria, 3052, Australia; e-mail: Simon.Harvey{at}RCH.org.au

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.

Editorial, see page 2117

This article was previously published in electronic format as an Expedited E-Pub on November 2, 2006, at www.neurology.org.

Dr. Spooner was supported by a grant from the Neurological Foundation of New Zealand. Dr. Harvey and J.A. Wrennall were supported by grants from the Murdoch Children's Research Institute.

Disclosure: The authors report no conflicts of interest.

Received April 10, 2006. Accepted in final form September 18, 2006.

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