Place of Surgery for Temporal Lobe Epilepsy During Childhood

Abstract

Ammon's horn sclerosis, or mesial temporal sclerosis as it is now often termed, is the most common single lesion found at necropsy in the brains of epileptic patients who have died a natural death. Long regarded as incidental or even secondary to major convulsions at any age, new evidence is accumulating that it is often the result of an asphyxial episode such as a severe febrile convulsion occurring in infancy. The nerve-cell loss is then followed by gliosis and scarring which “ripens” into an epileptogenic lesion in its own right and one which occurs commonly. The case histories of four patients, two adults and two in their teens, are described. All four had experienced severe febrile convulsions in infancy and had developed their habitual epilepsy shortly afterwards. In each patient the epilepsy proved resistant to drugs. Eventually each patient, after a long medical pilgrimage from one paediatric or epileptic centre to another, underwent a period of intensive E.E.G. and neuro-radiological investigations and was shown to be suffering from unilateral temporal lobe epilepsy. Each of the four patients then underwent a unilateral anterior temporal lobectomy which disclosed mesial temporal sclerosis. All were subsequently relieved of epilepsy and then began to live normal lives. Their case histories are related in detail as it is felt that there are many other persons with epilepsy in the community who could similarly be helped. Some guide lines are therefore given to the problems of recognition of temporal lobe epilepsy in childhood. © 1972, British Medical Journal Publishing Group. All rights reserved.