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Results for “Temporal Lobe Resection”

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PubMed2005

Greater functional recovery after temporal lobe epilepsy surgery in children.

The purpose of our study is to evaluate whether children recover better than adults from memory deficits as a consequence of temporal lobe surgery. We compared 3 and 12 month outcomes obtained in children and adults with medically refractory epilepsy. Each candidate underwent temporal lobe resection for seizure control and children were matched with regard to pathology, onset of epilepsy, side of surgery and type of surgery with adults (N = 30 for each group, mean age at surgery 13 versus 30 years). Three months after surgery, both left-resected groups displayed a significant decline in verbal learning capacity. During the following 9 months, only the children recovered and were able to reach their preoperative level 1 year after surgery. The left-resected adults remained, for the most part, on their low level and one year after surgery, they were still significantly worse than at the time of their preoperative examination. The right-resected adults experienced a deterioration in visual memory 1 year after surgery relative to the results of the short-term follow-up; the children improved. The children also had a better outcome with regard to attentional functions and, as a trend, a better seizure outcome (Engel Outcome I--1 year after surgery: 63% adults, 80% paediatric patients). Our neuropsychological data provide evidence of greater plasticity and compensational capacity in childhood. The results can be taken as a strong argument for early surgical intervention.

Adolescent↗

PubMed2001

Low-dose stereotactic radiosurgery is inadequate for medically intractable mesial temporal lobe epilepsy: a case report.

The successful surgical treatment of medically refractory epilepsy is based on one of three different principles: (1) elimination of the epileptic focus, (2) interruption of the pathways of neural propagation, and (3) increasing the seizure threshold through cerebral lesions or electrical stimulation. Temporal lobe epilepsy, being the most common focal epilepsy, may ultimately require temporal lobectomy. This is a case report of a 36-year-old male with drug-resistant right mesial temporal lobe epilepsy who failed to obtain seizure control after stereotactic radiosurgery to the seizure focus. Complex-partial seizures occurred 6-7 times monthly, and consisted of a loss of awareness followed by involuntary movements of the right arm. EEG/CC TV monitoring indicated a right mesial temporal lobe focus, which was corroborated by decreased uptake in the right temporal lobe by FDG-PET and by MRI findings of right hippocampal sclerosis. Stereotactic radiosurgery was performed with a 4MV linac, utilizing three isocenters with collimator sizes of 10, 10, and 7 mm respectively. A dose of 1500 cGy (max dose 2535 cGy) was delivered in a single fraction to the patient's right amygdala and hippocampus. There were no acute complications. Following radiosurgery the patient's seizures were improved in both frequency and intensity for approximately 3 months. Antiepileptic medications were continued. Thereafter, seizures increased in both frequency and intensity, occurring 10-20 times monthly. At 1 year post radiosurgery, standard right temporal lobectomy including amygdalohippocampectomy was performed with subsequent resolution of complex-partial seizures. Histopathology of the resected temporal lobe revealed hippocampal cell loss and fibrillary astrocytosis, consistent with hippocampal sclerosis. No radiation-induced histopathologic changes were seen. We conclude that low-dose radiosurgery doses temporarily changed the intensity and character of seizure activity, but actually increased seizure activity long-term. If radiosurgery is to be an effective alternative to temporal lobectomy for medically intractable temporal lobe epilepsy, higher radiosurgery doses will be required. The toxicity and efficacy of higher-dose radiosurgery is currently under investigation.

Adult↗

PubMed2005

Waterjet dissection versus ultrasonic aspiration in epilepsy surgery.

OBJECTIVE: Waterjet dissection is currently under close investigation in neurosurgery. Experimentally, precise brain parenchyma dissection with vessel preservation has been demonstrated. Clinically, the safety of the instrument has already been proved. However, precise data demonstrating that waterjet dissection indeed reduces surgical blood loss are still missing. METHODS: The authors applied the waterjet device in a prospective randomized study in comparison with the ultrasonic aspirator. Because there is little variability in the procedure, 30 patients with temporal lobe epilepsy receiving a tailored temporal lobe resection between December 1999 and October 2002 were selected for this study. Intraoperative vessel preservation, intraoperative blood loss, surgical complications, and epilepsy outcome were evaluated. All patients were followed at 3-month intervals. RESULTS: During surgery, both instruments were easy to handle. Only with the waterjet dissector, however, were even small intraparenchymal blood vessels preserved. Intraoperative blood loss was significantly reduced with the waterjet (mean, 70 +/- 46 ml) compared with the ultrasonic aspirator (mean, 121 +/- 48 ml). However, no difference in the necessity for blood transfusion occurred. No difference was observed with respect to operation time (238.6 +/- 37.0 min with the waterjet, 247.5 +/- 41.5 min with the ultrasonic aspirator), surgical complications, and outcome. CONCLUSION: The waterjet dissector enables a significant reduction of intraoperative blood loss in the investigated setting. However, further studies are needed to confirm these results with a larger number of patients. Studies also are needed to prove that the reduction of blood loss is of clinical relevance for the outcome of the patients.

Adolescent↗

PubMedDate not supplied

MR imaging volumetry of subcortical structures and cerebellar hemispheres in temporal lobe epilepsy.

BACKGROUND AND PURPOSE: There is mounting evidence of extratemporal volume changes associated with medically refractory temporal lobe epilepsy (TLE). This MR imaging study aimed to characterize volume changes in subcortical structures and cerebellar hemispheres with respect to lateralization of the seizure focus, onset and duration of epilepsy, and frequency of generalized tonic-clonic seizures (GTCS). METHODS: Amygdalar, hippocampal, thalamic, caudate head, and cerebellar volume measurements were obtained in the preoperative MR images of 40 patients with TLE (20 right, 20 left), who underwent temporal lobe resection with good outcome, and in 20 right-handed control participants. All 3D MR images were spatially aligned and normalized before measurements were obtained. Standardized volumes and right-to-left volume ratios (VRs) were compared between control participants and right and left TLE groups. Multiple regression analyses were performed to study the effects of epilepsy onset and duration and GTCS frequency on ipsilateral-to-contralateral VRs with respect to the resected seizure focus. RESULTS: Thalamic volumes were smaller bilaterally in patients with TLE. Hippocampal volumes were smaller ipsilateral to the seizure focus, but there was no significant volume loss involving the amygdala, caudate, or cerebellum. Hippocampal and amygdalar right-to-left VRs differed significantly between right and left TLE groups and controls, whereas thalamic right-to-left VRs differed only between the TLE groups. Thalamic ipsilateral-to-contralateral VRs were correlated positively with epilepsy onset and negatively with epilepsy duration. Caudate ipsilateral-to-contralateral VRs were positively, whereas amygdalar and cerebellar VRs were negatively, correlated with GTCS frequency. CONCLUSIONS: Unilateral amygdalar and bilateral thalamic volume loss, in the absence of caudate head atrophy, is likely to reflect seizure-induced injury due to TLE. Correlations of VRs affecting the amygdala, caudate, and cerebellum with GTCS frequency may also reflect injury or a prediposition for secondary generalization. Potential effects of complex partial seizures, febrile seizures, or antiepileptic medications on subcortical structures need to be evaluated in future studies.

Cerebellum↗

PubMed2001

Fluid-attenuated inversion recovery: correlations of hippocampal cell densities with signal abnormalities.

BACKGROUND: Hippocampal sclerosis (HS) is characterized by hippocampal atrophy and increased signal on T2-weighted images and on fluid-attenuated inversion recovery (FLAIR) images. OBJECTIVE: To quantitate cell loss and compare it with signal abnormalities on FLAIR images. METHODS: Thirty-one patients with temporal lobe resection, pathologically proven HS, and Engel class I and II outcome were included: 20 with HS only and 11 with HS associated with pathologically proven cortical dysplasia (dual pathology). The signal intensity on FLAIR was rated as present or absent in the hippocampus and correlated with the neuronal losses in the hippocampus. RESULTS: FLAIR signal increases were present in 77% (24/31) of all patients studied. In patients with isolated HS, 90% (18/20) had ipsilateral signal increases, but in patients with dual pathology, only 55% (6/11; p < 0.02) showed FLAIR signal increase. Hippocampal cell losses were significantly higher in the isolated HS group. The average cell loss in patients with FLAIR signal abnormalities was 64.8 +/- 8.0% as compared with only 32.7 +/- 5.1% in patients with no FLAIR signal abnormalities. There was a significant positive correlation between the presence of signal abnormality and average hippocampal cell loss in both pathologic groups. CONCLUSIONS: Ipsilateral FLAIR signal abnormalities occur in the majority of patients with isolated HS but are less frequent in those with dual pathology. The presence of increased FLAIR signal is correlated with higher hippocampal cell loss.

Adult↗

PubMed1993

Magnetic resonance imaging in childhood intractable partial epilepsies: pathologic correlations.

We conducted a retrospective single-blind study assessing the value of MRI in 44 children surgically treated for partial epilepsy, and correlated the MRI findings with the pathology in all cases. MRI revealed abnormalities in concordance with the clinical and electroencephalographic data in 84% of patients. Developmental neuronal migration pathology was present in 25% of patients and was relatively more common in the sensorimotor cortex. There was hippocampal sclerosis in 50% of patients with temporal lobe resection; however, only two of the 10 children with hippocampal sclerosis were below the age of 12 years. Similarly, ganglio-glial tumors were more common than astrocytomas in children below age 12. These results indicate that MRI is sensitive in the detection of pathologic abnormalities in most pediatric candidates for epilepsy surgery, and that the distribution and type of pathology appear to be age related in this population.

Adolescent↗

PubMed1998

Functional plasticity after left anterior temporal lobectomy: reconstitution and compensation of verbal memory functions.

PURPOSE: This study investigated the functional plasticity of the brain to reconstitute and compensate for verbal memory functions after epilepsy surgery of left temporocortical and temporomesial structures. We hypothesized that memory outcome would be best when surgery is performed within the period of cerebral plasticity, and that the outcome should be worst when fluid intelligence starts to decrease with physiologic aging. We also raised the question of different plasticity and compensation mechanisms for temporomesial and temporocortical memory functions. METHODS: We evaluated preoperative and 1-year-postoperative memory data and other verbal functions in 104 patients with epilepsy, who underwent a standard left anterior temporal lobe resection. We used memory measures that had been previously shown to be most selective for mesial and lateral functions, respectively. Determinants of postoperative memory outcome were evaluated by multiple regression analysis. Group statistics were calculated on the basis of the periods that are usually assumed to be significant for plasticity and behavioral compensation. Individual postoperative changes in memory functions were evaluated on the basis of test-retest data obtained in a group of 100 nonsurgical patients with localization-related epilepsies (mean retest interval >12 months). RESULTS: Only changes in cortically represented learning and data acquisition were related to age, plasticity, and capacities for behavioral compensation. No patient in the youngest group (younger than 15 years), 33% of patients who had surgery between the ages of 15 and 30 years, and 61% of the patients undergoing surgery older than age 30 years had significant deterioration in verbal learning. In contrast, postoperative changes in temporomesial consolidation/retrieval processes were independent of age at the time of surgery, plasticity, and capacities for behavioral compensation. CONCLUSIONS: Our data indicate different time windows for the reconstitution and compensation of mesial and cortical aspects of memory. Whereas the reconstitution of and compensation for cortical functions appear restricted by decreasing plasticity and physiological aging, mesial functions seem to be reconstituted by contralateral mesial structures over a much longer period. Concerning drug-resistant localization-related epilepsies, our results justify early consideration of surgery, especially when cortical structures are affected.

Adolescent↗

PubMed2005

Multipotent progenitor cells from the adult human brain: neurophysiological differentiation to mature neurons.

It was long held as an axiom that new neurons are not produced in the adult human brain. More recent studies have identified multipotent cells whose progeny express glial or neuronal markers. This discovery may lead to new therapeutic strategies for CNS disorders, either by stimulating neurogenesis in vivo or by transplanting multipotent progenitor cells (MPCs) that have been propagated and differentiated in vitro. The clinical application of such approaches will be limited by the ability of these cells to develop into functional neurons. To facilitate an understanding of mechanisms regulating neurogenesis in the adult human brain, we characterized the developmental processes MPCs go through when progressing to a neuron. Human tissue was harvested during temporal lobe resections because of epilepsy, and cells were cultured as neurospheres. Our findings demonstrate that at an early stage, these cells often stain with neuronal markers without possessing any functional neuronal properties. Over a period of 4 weeks in culture, cells go through characteristic steps of morphological and electrophysiological development towards functional neurons; they develop a polarized appearance with multiple dendrites, whereas the membrane potential becomes more negative and the input resistance decreases [from -48 +/- 10 mV/557 +/- 85 MOmega (n = 15) between days 7 and 11 to -59 +/- 9 mV/380 +/- 79 MOmega (n = 9) between days 25 and 38, respectively]. Active membrane properties were first observed on day 7 and consisted of a voltage-gated K+-current. Later in the second week the cells developed voltage-gated Ca2+-channels and fired small Ca2+-driven action potentials. Immature Na+-driven action potentials developed from the beginning of the third week, and by the end of the fourth week the cells fired repetitive action potentials with a completely mature waveform generated by the combined action of the voltage-gated ionic channels INa, IA and IK. After 4 weeks, the newly formed neurons also communicated by the use of GABAergic and glutamatergic synapses. The adult human brain thus harbours MPCs, which have the ability to develop into neurons and in doing this follow characteristic steps of neurogenesis as seen in the developing brain.

Adult↗

PubMed1994

Activity of S-adenosylmethionine decarboxylase, a key regulatory enzyme in polyamine biosynthesis, is increased in epileptogenic human cortex.

OBJECTIVE: We measured the activity of S-adenosylmethionine decarboxylase, a key regulatory enzyme of polyamine biosynthesis, in the temporal cortex of patients with epilepsy. DESIGN: Cortical surgical specimens were obtained following anterior temporal lobe resection for intractable epilepsy. Enzyme activity was compared in nonepileptogenic (n = 16) and epileptogenic (spontaneously discharging; n = 19) regions. RESULTS: Mean enzyme activity was increased by 44% in samples from epileptogenic cortex compared with samples from nonepileptic regions. The S-adenosylmethionine decarboxylase activity in regions of focal epileptogenic discharges was also increased in five patients compared with paired samples from the nonepileptogenic portion of the same gyrus (+55%). CONCLUSIONS: Elevated activity of S-adenosylmethionine decarboxylase in regions of active epileptogenic cortical discharges suggests that a disturbance of the polyamine system may be involved in the maintenance of hypersynchronous discharges, perhaps through a modulatory action at the excitatory N-methyl-D-aspartate-preferring glutamate receptor.

Adenosylmethionine Decarboxylase↗

PubMed2001

Effect of divalproex-lamotrigine combination therapy in frontal lobe seizures.

CONTEXT: Patients with intractable frontal lobe seizures represent a difficult subclass of patients with epilepsy. When medications fail, surgical outcomes typically have not been as successful as medial temporal lobe resections. The combination therapy of valproic acid (divalproex sodium) and lamotrigine has shown promising results in patients with uncontrolled seizures. OBJECTIVE: To determine outcome in patients with intractable frontal lobe seizures who were treated with the combination of divalproex and lamotrigine. DESIGN: A nonrandomized, open-label, add-on trial. SETTING: Outpatients evaluated and treated at a tertiary care referral facility. PATIENTS: Twenty-one patients between 16 and 65 years old were studied. Patients were required to have failed at least 3 prior trials with antiepilepsy drugs. Criteria for frontal lobe onset included 1 or more of the following: frontal lesion on scan, positive ictal single-photon emission computed tomographic scan, symptoms consistent with frontal lobe onset, or an electroencephalogram (surface or invasive) consistent with frontal lobe onset. INTERVENTION: Patients were treated with divalproex-lamotrigine combination therapy for 1 year. MAIN OUTCOME MEASURES: The main outcome measured was seizure reduction. Safety and tolerability were also evaluated. RESULTS: Four patients discontinued therapy. Ten of the remaining 17 became completely free of seizures. Two rashes occurred, but did not lead to discontinuation of therapy. The most common adverse events were tremor and weight gain. CONCLUSION: Divalproex-lamotrigine combination therapy is a reasonable alternative in intractable frontal lobe epilepsy.

Adolescent↗

PubMed1998

Fibroblast growth factor-2/brain-derived neurotrophic factor-associated maturation of new neurons generated from adult human subependymal cells.

The adult mammalian forebrain harbors neuronal precursor cells in the subependymal zone (SZ). Neuronal progenitors also persist in the adult human SZ and have been cultured from epileptic temporal lobe. In the present study, we sought to identify these neural progenitors in situ, and to direct their expansion and neuronal differentiation in vitro. We prepared explants of adult human SZ, obtained from temporal lobe resections of refractory epileptics. The resultant cultures were treated with fibroblast growth factor-2 (FGF-2) for a week, with concurrent exposure to [3H]thymidine, then switched to media containing brain-derived neurotrophic factor (BDNF) for up to 2 months. Sporadic neuronal outgrowth, verified antigenically and physiologically, was observed from SZ cultures regardless of FGF-2/BDNF treatment; however, only FGF-2/BDNF-treated cultures exhibited profuse outgrowth, and these displayed neuronal survival as long as 9 weeks in vitro. In addition, cortical cultures derived from two brains generated microtubule-associated protein-2+ neurons, which incorporated [3H]thymidine and exhibited significant calcium increments to depolarization. In histological sections of the subependyma, both uncommitted and restricted progenitors, defined respectively by musashi and Hu protein expression, were identified. Thus, the adult human subependyma harbors neural progenitors, which are able to give rise to neurons whose numbers can be supported for prolonged periods in vitro.

Adult↗

PubMed2003

Expression of complement messenger RNAs and proteins by human oligodendroglial cells.

Neurons, astrocytes, microglia, and endothelial cells are capable of synthesizing most, if not all, of the complement proteins. Little is known, however, about the capacity of oligodendroglial cells to generate complement components. This study evaluated expression of complement mRNAs and their protein products by human oligodendrocytes. Cells were isolated and cultured from white matter of seven adult cases that had undergone surgical temporal lobe resection for epilepsy. Oligodendroglial cultures were characterized by the expression of such cell type-specific mRNAs as myelin proteolipid protein (PLP), oligodendrocyte-specific protein (OSP), and 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) and were further characterized by immunostaining for such differentiation markers as myelin basic protein (MBP), PLP, CNPase, and O4. RT-PCR analysis showed that the oligodendroglial cells expressed detectable levels of complement mRNAs for the C1q B-chain, C1r, C1s, C2, C3, C4, C5, C6, C7, C8 gamma subunit, and C9. Immunostaining was positive for C1q, C1s, C2, C3, C4, C5, C6, C7, C8, and C9. Double immunostaining for the oligodendrocyte marker O4 and the complement protein C3 demonstrated that all O4-positive cells were also positive for C3, indicating constitutive C3 expression. These results indicate that oligodendroglial cells may be a source of complement proteins in human brain and thus could contribute to the pathogenesis of several neurodegenerative and inflammatory diseases of the CNS, such as Alzheimer's disease, multiple sclerosis, and progressive supranuclear palsy, where complement-activated oligodendrocytes are abundant.

Adult↗

PubMed2004

Surgical anatomy of the insula.

The insula is the only cortical part of the brain which is not visible on the surface of the hemisphere. This is due to the fact that it is totally covered by the fronto-parietal and temporal opercula. The insula has a triangular shape, and is separated from the opercula by the anterior, superior, and inferior periinsular sulci. The limen insulae is the antero-inferiorly located insular cortical surface which conjoins the inferior insular point, the anterior perforated surface, and the temporo-mesial surface. The insula is morphologically divided into two parts by the central insular sulcus. The anterior part of the insula bears 3 gyri: the anterior, middle, and posterior short insular gyri, separated by the anterior and precentral insular sulcus. The posterior part of the insula contains the anterior and posterior long insular gyri, separated by the postcentral insular sulcus. The vascular supply of the insula is mainly provided by the M2 segment of the middle cerebral artery, which constitutes a substantial obstacle to any open or stereotactic procedure aiming at the insular region. Histologically, the insula is a part of the paralimbic cortex, as it bears in its antero-inferior part an allo and mesocortical area. The insula is functionally involved in cardiac rhythm and arterial blood pressure control, as well as in viscero-motor control and in viscero-sensitive functions. There is considerable evidence for the involvement of the insula as a somesthetic area, including a major role in the processing of nociceptive inputs. Its possible role in some epilepsies may explain some failures of temporal lobe resection. Surgery of the insular lobe is a technical challenge, whose risks can be minimized by the use of intra-operative direct cerebral stimulation.

Animals↗

PubMed1997

Outcome and life prospects after surgical management of medically intractable epilepsy in patients under 18 years of age.

A retrospective analysis of seizure outcome and quality of life assessment was done in 64 patients under 18 years of age with medically refractory epilepsy who underwent 64 primary and 16 repeat operative procedures in an attempt to control their epilepsy. At least 2 years' follow-up data were available for each patient. Operative procedures were 44 temporal lobe resections; 16 extratemporal resections; and 4 hemispherectomies. Effective control of previously intractable seizures was obtained in most patients: 55%, 11%, and 17% achieved Engel class I, II, and III status, respectively. Successful seizure control was thus obtained in 83%, while 17% (Engel class IV) failed to improve significantly after operation. Quality-of-life measures parallelled the improvements in seizures control, being highest in Engel I, outcome group and lowest in Engel IV outcome group. In appropriately selected pediatric and adolescent patients with medical refractory epilepsy, surgical management can offer a safe and effective adjunct to medication.

Adolescent↗

PubMed1989

DNA synthesis by young adult human-derived astrocytes in vitro.

We have assessed whether adult human non-neoplastic astrocytes exhibit DNA synthesis in vitro, as measured using a double immunofluorescence technique to detect incorporation of 5-bromodeoxyuridine (BrdU) by nuclei of glial fibrillary acidic protein (GFAP)-containing cells. Dissociated cell cultures containing GFAP+ cells were established from surgically resected temporal lobe tissue from 3 young adult individuals operated upon to remove epileptogenic foci. In 5-18-day-old cultures from each of the 3 individuals, we observed GFAP+ cells whose nuclei had incorporated BrdU. BrdU nuclear staining was found in GFAP+ cells with either flat or process-bearing morphologies. The mean mitotic index for the GFAP+ cells was 6% (range 2-12%) as compared to a mean mitotic index of 29% for the GMK-7 glioma cell line. Our results do indicate that astrocytes derived from young adult donors, unlike such cells derived at autopsy from elderly adults, are capable of DNA synthesis in vitro, albeit to a markedly lesser extent than reported for fetal human astrocytes.

Adult↗

PubMed1992

A re-appraisal of a case of persistent global amnesia following right temporal lobectomy: a clinico-pathological study.

We report a reappraisal of patient NT who became severely amnesic after a right temporal lobectomy for intractable epilepsy (DINSDALE et al., Neuropsychologia 1, 287, 1964 [6]). Histological examination, albeit incomplete, indicated that there was no abnormality in the resected temporal lobe. At autopsy a sclerotic lesion of the unoperated left hippocampal formation was found. This case is therefore not an exception to the general rule that a severe and global amnesic state is only observed with bilateral lesions. Her performance on a wide range of memory tests is shown to be indistinguishable from patients with an amnesic syndrome due to Korsakoff's psychosis.

Aged↗

PubMed1982

Selective amygdalohippocampectomy as a surgical treatment of mesiobasal limbic epilepsy.

We report indications and techniques as well as preliminary results of a new microsurgical method of treatment for patients with drug-resistant psychomotor epilepsy in whom mesiobasal temporal lobe epilepsy has been diagnosed. The most important reason for surgical intervention in our series of 27 patients was their epilepsy. In 12 patients a tumor of the amygdala and/or hippocampal formation was suspected or had been proved. In 13 patients the amygdala and/or hippocampus had been delineated as the epileptogenic area by long-term monitored stereo-electroencephalography. In the remaining 2 patients, clear-cut ictal findings on surface electroencephalography allowed operation. Preliminary results of this selective surgical procedure are very promising. They indicate that this type of psychomotor epilepsy can be treated more successfully in ths new way than by the classic removal of the temporal lobe or by stereotactic methods. After 6 to 73 months of follow-up (mean = 21), 22 patients were free of seizures. The postoperative neuropsychological follow-up studies showed better results than those for patients who underwent large temporal lobe resections. In more than half of the patients a clear-cut general improvement in tests of intellectual performance was found. Learning and memory impairments were also much less pronounced or even undetectable.

Adult↗

PubMed1999

Epilepsy surgery in children with pervasive developmental disorder.

Pervasive developmental disorder (PDD) is occasionally associated with medically intractable complex partial seizures. The outcome of PDD was explored in three males and two females who underwent epilepsy surgery at 32 months to 8 years of age (mean = 4 years) after onset of epilepsy at 1 week to 21 months of age (mean = 11 months). Four children had temporal lobe resections (three right, one left; two for focal cortical dysplasia, and two for tumors), and one had a right temporoparieto-occipital resection (for focal cortical dysplasia). Each child underwent repeated evaluations by a pediatric neuropsychologist and psychiatrist. Fourteen to 47 months (mean = 23 months) after operation, one child with persistent seizures had moderate developmental and behavioral improvement, three children (two seizure free, one with rare staring spells) had mild developmental and behavioral improvement, and the remaining child (seizure free) experienced a worsening of her PDD. The four children with mild-to-moderate improvement in postoperative cognitive and behavioral development still demonstrated persistent delay. Cognitive gains were confirmed by neuropsychologic testing in the oldest patient but were not reflected in test results from the three younger children, who had more modest improvement. The child with worsening of her PDD had cognitive and emotional deterioration to babbling, echolalia, aggressiveness, decreased social interaction, and increased mouthing of objects beginning several months postoperatively. These results suggest that families should be counseled that PDD symptoms in children with focal epileptogenic lesions may or may not improve after epilepsy surgery, even if the surgery is successful with respect to seizure control.

Child↗