UK Department of Health National Institute for Health Research (NIHR) Biomedical Research Centres funding scheme, Epilepsy Society, Dr Marvin Weil Epilepsy Research Fund.

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.

Summary:Background: While some patients experience a decline in memory function following an anterior temporal lobe resection, there is considerable individual variation in the extent, nature, and direction of postoperative memory change. Patients with surgically remediable temporal lobe epilepsy differ in etiology, the extent and type of underlying pathology, and on demographic and epilepsy-related variables, all of which may have an impact on their pre-and postoperative neuropsychological functioning. This study examined the relationship between these variables and postoperative memory decline.Methods: Logistic regression was used to examine the effects of age, laterality of surgery, age of onset of epilepsy, underlying pathology and preoperative level of memory function on postoperative verbal learning in 288 patients who had undergone an anterior temporal lobe resection. One hundred twenty-five patients underwent a right temporal lobe resection (RTL), 163 patients underwent a left temporal lobe resection (LTL). Results:In the group as a whole, 25% of the patients demonstrated a significant postoperative deterioration in verbal learning. Postoperative deterioration in verbal learning was significantly associated with higher levels of preoperative function in both the RTL and LTL groups. Older age at the time of the operation and a lower verbal IQ were additional significant predictors for the RTL group. The presence of cortical dysgenesis was a significant predictor of postoperative decline in the LTL group. The logistic regression models accurately identified 3/4 of those who experienced a postoperative decline in memory, using a cutoff of 0.25 or above to identify high risk.Conclusions: Our analyses suggest that the majority of patients with a high risk of significant postoperative memory decline can be reliably identified preoperatively. These models are valuable tools helping patients make an informed decision regarding surgery.

Craniosynostosis management partially depends on the detection and treatment of elevated intracranial pressure (ICP). Examination for papilledema is considered to be the most reliable screening method for identifying raised ICP, but its effectiveness has not been defined. One hundred and twenty-two children with craniosynostosis who underwent funduscopic examinations and then Camino ICP monitoring were studied. All eye examinations were performed by an ophthalmologist after pharmacological pupillary dilation. Fifteen patients (12%) had papilledema. Subsequent ICP monitoring showed that the median ICP was 12.7 mm Hg, with 41 patients (34%) having elevated ICPs (> 15 mm Hg). Those with papilledema had higher ICPs (17.5 +/- 3.2 versus 12.7 +/- 5.5 mm Hg), were older (5.9 +/- 4.7 versus 1.9 +/- 2.6 years), and were more likely to have craniofacial syndromes (73 versus 41%) than those without papilledema (P < 0.05). Patients with both elevated ICPs and papilledema were older (5.9 +/- 4.7 versus 1.6 +/- 1.4 years) and more likely to have multiple-suture synostosis (92 versus 61%) than those with elevated ICPs and no papilledema (P < 0.05). The presence of papilledema was a specific (98%) indicator of raised ICP, but its sensitivity was age-dependent. It was 100% sensitive in children older than 8 years, but it indicated elevated ICP in only 22% of younger patients. These results suggest that ICP monitoring to document elevated ICP is unnecessary in children older than 8 years who have detailed ophthalmological examinations. In the younger child, the presence of papilledema reliably indicates elevated ICP but its absence does not rule out elevated ICP; formal ICP measurement has a greater role in detecting elevated ICP in these patients.