DEVELOPMENTAL ASPECTS OF FOCAL EPILEPSIES OF CHILDHOOD TREATED BY NEUROSURGERY

Abstract

Data on 50 patients treated surgically for intractable focal epilepsy were analyzed. There were 10 hemispherectomies, 32 temporal lobectomies and 8 operations to other areas of the brain. The median age at operation was 14 yr; 29 patients had mesial temporal sclerosis of sclerotic hemispheres and 17 had alien tissue and 1 sclerosis with heterotopia. No lesion was found in 3 cases. The nature of the 1st seizure was related significantly to pathology; 30 patients had suffered an early convulsion. Between the convulsive insult and the onset of focal epilepsy there was a silent interval, the duration of which was biased by sex and side of lesion. The remaining 20 patients, of whom a highly significant number had alien tissue, had not had an early convulsion before the onset of focal epilepsy. The importance of accurate clinical histories is stressed. Clinical considerations alone predicted the pathology and laterality of the lesion in more than half the series. Regular EEG recordings and repeat scanning were important investigations. Major disorders of behavior had occurred in 44 patients. As adults, the series were free of severe psychiatric symptoms, but many required years of careful rehabilitation; 31 children had been excluded from normal schools before operation. Postoperatively, many patients continued their education in normal schools. Some required basic remedial teaching, other successfully undertook higher education and training; 49 patients benefited over-all from neutrosurigcal treatment; 34 had no more habitual epilepsy at all. Full global gains often took at least 5 yr to achieve.