TEMPORAL LOBE SYNDROME IN CHILDREN

Abstract

Twenty children with a well-defined temporal lobe electroencephalographic focus were studied for a period averaging 7 years. A careful search was conducted for etiologic factors, and correlation of psychological patterns with electroencephalographic findings was carried out. In addition neurologic deficit, psychometric findings and social adjustment were studied. A genetic etiology was suspected in half of the patients on the basis of a clear history of epilepsy, a severe psychiatric disturbance, or the presence of a temporal lobe focus in a close relative, although a familial incidence was well documented in only 3 of the 10 patients. Hippocampal sclerosis secondary to herniation of the temporal lobe uncus and compromise of its circulation was thought to be etiologic in two small premature infants who experienced marked neonatal asphyxia, and in one child who suffered a severe head injury. A cystic astrocytoma had caused focal motor seizures in one patient for a 7-year period prior to its total removal. A wide pattern of psychologic diagnosis was noted, ranging from four normal to six psychotic, four hyperactive, four neurotic and two retarded children. All psychotic children had either a unilateral midtemporal spike focus or spike foci arising independently in both temporal lobes. Three of the four patients with bilateral abnormalities were psychotic, a finding that might be related to the bizarre behavioral changes in animals which have undergone bilateral temporal lobectomy. Neurologic abnormalities were restricted to mild speech disorders in two patients with normal intellect, a finding possibly related to the expressive language functions centered in the temporal lobe. Eighteen of the 20 patients were functioning in the normal intellectual range, 2 were mentally deficient and the other 3, although functioning in the subnormal range, had normal intellectual potential. Social maladjustment, resulting from serious behavioral and psychologic disturbances and incomplete control of psychomotor seizures, affected 15 of the 20 patients in the early phase of the study. Follow-up examinations revealed improvement in six of the socially handicapped patients. This improvement occurred with all types of temporal lobe electroencephalographic abnormality, excluding those with anterior temporal spike activity. All 11 patients who had psychomotor seizures were incompletely controlled after vigorous, prolonged attempts at medical management. Grand mal attacks were seen in 15 of the patients and were easily controlled. Surgery for the relief of seizures was performed in three patients and benefited only the one whose tumor was removed. The other two patients, who underwent limited subpial resections, showed no improvement.