The relationships between etiology, age at onset and electroclinical findings were examined in 77 children with temporal lobe epilepsy (TLE) reported from University of Verona, Verona, and Niguarda Hospital, Milan, Italy. Age at onset was < 3 years in 39 patients, 3 to 6 years in 17, and > 6 years in 21. Seizures began with staring, lip cyanosis, and oral automatisms; auras were more common after age 6 years. Video-EEG recordings documented seizures starting independently in both temporal lobes. Three subgroups of TLE were recognized: 1) Symptomatic TLE caused by cortical malformation or tumor; 2) TLE with mesial temporal sclerosis; and 3) cryptogenic TLE. Thirty two patients underwent surgical treatment. [1]
COMMENT. Video-EEG recording of seizures is essential for correct diagnosis and localization of TLE in young children. In cases lacking neuroradiological correlation, a repeat video-EEG may be needed at follow-up. Wyllie E et al [2], in a previous electroclinical study of 14 children aged 16 months to 12 years, also demonstrated the value of video-EEG recordings in pre-surgical localization of the epileptogenic zone in children with TLE, especially in cases with mesial sclerosis and without tumor. In 9 with low grade neoplasms, the EEG findings were complex, including multifocal interictal sharp waves or falsely lateralized EEG seizure onset. An excellent surgical outcome is reported in 19 patients with mesial temporal sclerosis following prolonged complex febrile seizures and treated at the Montreal Neurological Institute [3]. Ictal SPECT was superior to ictal EEG in localizing value in a study of 15 children with TLE, aged 7-14 years, at Royal Children's Hospital, Melbourne, Australia [4].