Abstract
The temporal lobe is a common focus for epilepsy. Temporal lobe epilepsy in infants and children differs from the relatively homogeneous syndrome seen in adults in several important clinical and pathological ways. Seizure semiology varies by age, and the ictal EEG pattern may be less clear cut than what is seen in adults. Additionally, the occurrence of intractable seizures in the developing brain may impact neurocognitive function remote from the temporal area. While many children will respond favorably to medical therapy, those with focal imaging abnormalities including cortical dysplasia, hippocampal sclerosis, or low-grade tumors are likely to be intractable. Expedient workup and surgical intervention in these medically intractable cases are needed to maximize long-term developmental outcome.
Highlights
The temporal lobe plays a vital role in epilepsy and is the most frequent lobe involved in focal onset seizures
The epileptiform discharges and epilepticus in slow-wave sleep (ESES) in continuous spike-wave during slow-wave sleep syndrome (CSWS) occur maximally over the frontal head regions, which correlates with the global regression, expressive language abnormalities, and motor impairment seen in these children
Like Landau Kleffner syndrome (LKS) and CSWS, the EEG in benign childhood epilepsy with centrotemporal spikes (BCECTSs) demonstrates dramatic activation of epileptiform discharges during sleep, typically occupying less than 85% of the sleep record
Summary
The temporal lobe plays a vital role in epilepsy and is the most frequent lobe involved in focal onset seizures. Temporal lobe epilepsy in children and infants has clear clinical features which make it distinct from the fairly homogeneous syndrome seen in adults. Reported studies of temporal lobe epilepsy (TLE) in children are heavily biased towards those with medically intractable epilepsy, and few studies focus on cohorts who are newly diagnosed. This paper will address pediatric-specific aspects of TLE, including clinical semiology in young children, pediatric epilepsy syndromes involving the temporal lobe, medical and surgical management, associated psychiatric and cognitive disorders, and long-term outcomes
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