Temporal Lobe Epilepsy in Children: Electroclinical Study of 77 Cases

Abstract

Summary:Purpose: Temporal lobe epilepsy (TLE) is probably more difficult to recognize in children than in adults. In fact, ictal symptoms in children are less stereotyped and less obvious, and the neuropathological substrate is more heterogeneous than in adults. The aim of this study is to examine the relationships between etiology, age at onset and electroclinical findings in 77 children with TLE, 32 of whom were surgically treated.Methods: Electroclinical study including video-EEG recording of seizures in 77 children with TLE. The investigation focused on the first five initial ictal symptoms.Results: Age at onset was less than 3 years in 39 cases, between 3 and 6 years in 17 cases and older than 6 years in 21 cases. Auras also occurred in younger children but were more common after the age of 6 years. A peculiar initial ictal semiology consisted in staring with arrest, lip cyanosis, and very slight oral automatisms.In some cases, EEG recordings documented seizures starting independently on both temporal lobes. Based on electroclinical and neuroradiological features, we recognized three subgroups: symptomatic TLE due to cortical malformations or nonevolutive tumors, TLE with mesial temporal sclerosis, and cryptogenic TLE.Conclusions: A correct electroclinical and neuroradiological approach allows in several cases early recognition of TLE even when onset is earlier than the age of 6 years. A correct definition of the localization relies primarily on video-EEG recording of the seizures, possibly repeated during follow up in cases lacking obvious neuroradiological correlation.

Temporal Lobe Epilepsy With Hippocampal Sclerosis in Acute Lymphoblastic Leukemia

“…[12][13][14] Recently, cases of very rare MTLE-HS associated with hematologic malignancies have been reported, [6][7][8][9][10] wherein seizures induced by chemotherapy or cranial irradiation were suspected as IPIs.…”

Temporal Lobe Epilepsy in Children

“…Although automatisms can be seen in infants and toddlers with TLE, they are typically simpler than those observed in older children and adults [9, 10, 12, 22–25]. These simpler automatisms include oroalimentary (lip smacking), gestural (hand fumbling), and blinking movements [9, 12, 24, 25]. This difference may arise from the limited repertoire of voluntary fine motor gestures in young children.…”

“…Given the lack of well-developed verbal communication skills in children aged 0–3 years, it is usually impossible for clinicians to properly assess for auras at seizure onset [9, 12, 26]. Rather, the earliest signs of such seizures in infants and toddlers may be behavioral arrest, staring, and lip cyanosis [25]. …”

“…This age group is more likely to demonstrate dystonic posturing, versive/nonversive head turning, and eye/mouth deviation [9, 23, 25, 27]. Dystonic posturing, eye/mouth deviation, and versive head turning have been found to lateralize to the contralateral hemisphere in this population, with correct lateralization in 75–100% of cases [23].…”

“…These include the oroalimentary automatisms seen in younger (age 0–3 years) children in addition to staring, looking around, and/or hand clapping [9, 10, 23, 25]. However, more complex automatisms are still less likely to be observed in this age group versus older children (age >6 years) and adults [23, 25]. They are also less likely to correctly lateralize to the ipsilateral hemisphere than in older children (50% versus 100%) [23].…”