Effects of temporal lobectomy on consciousness-impairing and consciousness-sparing seizures in children
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Most children with medically refractory temporal lobe epilepsy (TLE) become seizure free after temporal lobectomy, but some individuals continue to seize. As studies of temporal lobectomy typically focus on seizure freedom, the effect of surgery on seizure type and frequency among children with persistent seizures is poorly understood. Seizures which impair consciousness are associated with increased morbidity compared to consciousness-sparing seizures.
A retrospective cohort study was performed to evaluate the effects of temporal lobectomy on seizure type and frequency in children with intractable TLE.
Among 58 pediatric TLE patients with a mean (±SEM) age of 14.0 ± 0.7 years who received temporal lobectomy, 46 (79.3 %) individuals achieved an Engel class I seizure outcome, including 38 (65.5 %) children who became completely seizure free (Engel IA). Mean follow-up was 2.7 ± 0.4 years. While the number of patients experiencing simple partial seizures (SPSs) (consciousness sparing) decreased by only 23 % after surgery, the number of children having complex partial seizures and generalized tonic–clonic seizures (consciousness impairing) diminished by 87 and 83 %, respectively (p < 0.01). SPS was the predominant seizure type in only 11.3 % of patients before resection, but in 42.1 % of patients with postoperative seizures (p < 0.01). Children with postoperative seizures experienced a 70 % reduction in overall seizure frequency compared to baseline (p < 0.05), having consciousness-impairing seizures 94 % less frequently (p < 0.05), but having consciousness-sparing seizures 35 % more frequently (p = 0.73).
Seizure type and frequency are important considerations in the medical and surgical treatment of children with epilepsy, although complete seizure freedom remains the ultimate goal.