Objective: Temporal lobe resection is an established treatment for medication-resistant temporal lobe epilepsy, which in recent years has increasingly been performed in children. However, little is known about the long-term outcome in these children. The aim of this study was to characterize intellectual and psychosocial functioning of children after temporal lobe resection as they progress into late adolescence and adulthood. Methods:We report the long-term follow-up of 42 children who underwent temporal lobe surgery after an average postoperative period of 9 years. Longitudinal change in IQ was documented, psychosocial outcome including quality of life was assessed, and preoperative and postoperative T1-weighted MRI brain scans were evaluated quantitatively. A well-matched nonsurgical comparison group of 11 children with similar clinical characteristics was also assessed.Results: At follow-up, 86% of the surgical group were seizure-free, and 57% were no longer taking antiepileptic medication. A significant increase in IQ was found in the surgical group after an extended follow-up period of Ͼ5 years. This IQ change was not found in the nonsurgical comparison group. IQ increases were associated with cessation of antiepileptic medication and changes in MRI-derived gray matter volume. The surgical group also reported better psychosocial outcome including quality of life, which was more strongly associated with seizure freedom rather than surgery per se. Conclusions:Surgery for temporal lobe epilepsy performed in childhood results in excellent long-term seizure control and favorable cognitive outcome along with positive effects on brain development. Classification of evidence:This study provides Class III evidence that temporal lobectomy in children with temporal lobe epilepsy is associated with improved long-term intellectual outcomes compared with those undergoing standard medical treatment. Neurology Medication-resistant temporal lobe epilepsy (TLE) is often caused by brain abnormalities such as tumors or hippocampal sclerosis. Surgical removal of such lesions results in excellent seizure control.1 When surgical treatment for TLE in children is considered, factors such as the impact of seizures and medication on brain development and function have to be taken into account.2 Because children with poor seizure control show a decrease in intellectual functioning over time, 3 it is thought that early surgical intervention could reduce the severity of cognitive impairment.

The profile of attentional impairments and fluctuating attention is similar in PD dementia and DLB with parkinsonism. The current findings do not support the current arbitrary distinctions between these patient groups. Importantly, patients with PD do not experience fluctuating attention.

This large prospective study confirms that slowing of cognitive processing, attention, and fluctuations of attention are significantly more pronounced in DLB and AD patients, although fluctuating attention is common in patients with moderate-to-severe AD. Deficits of cognitive reaction time appear to be specific to DLB, except in severe dementia. A detailed evaluation of attentional performance could make an important contribution to differential diagnosis, although the results need to be interpreted within the context of the overall severity of cognitive deficits.

Summary:Purpose: The aim of this study was to examine the impact of clinical variables, particularly age at onset of epilepsy, on intellectual function in a group of children with temporal lobe epilepsy (TLE).Methods: We reviewed the preoperative neuropsychological test results of 79 children with unilateral TLE who subsequently underwent surgical resection. The impact of age at onset and duration of epilepsy, pathology type, and side of resection on full-scale intelligence quotient (IQ) scores was examined.Results: Intellectual dysfunction (defined as IQ <79) was present in 57% of children, and age at onset of epilepsy was the best predictor of intellectual function. Children with epilepsy onset in the first year of life had a particularly high incidence of intellectual impairment (82.4%).Conclusion: These data suggest a critical period during the first year of life for the subsequent development of intellectual abilities and highlight the importance of early treatment in this population.

See Berg (doi:) for a scientific commentary on this article.In a long-term follow-up study of children who underwent temporal lobe surgery for treatment of epilepsy, Skirrow et al. identify no significant pre-to-post-surgery memory losses, but instead robust improvements in memory functions supported by the unoperated temporal lobe. The integrity of remaining temporal lobe structures places constraints on long-term memory outcomes.