Temporal Encephalocele: A Treatable Etiology of Drug-Resistant Pediatric Temporal Lobe Epilepsy.

Abstract

BACKGROUND:

Temporal lobe encephaloceles (TEs) are a rare cause of drug-resistant temporal lobe epilepsy (DR-TLE), with head trauma and obesity identified as risk factors in adults. This study evaluated the clinical characteristics of childhood-onset DR-TLE due to TE.

METHODS:

This is a single-institution retrospective review of childhood-onset DR-TLE with radiographic TE identified between 2008 and 2020. The epilepsy history, brain imaging features, and surgical outcomes were collected.

RESULTS:

Eleven children with DR-TLE due to TE were included (median age at epilepsy onset was 11 years, interquartile range 8.5 to 13.5 years). Median latency between epilepsy diagnosis and TE detection was 3 years (range of 0 to 13 years). None had history of head trauma. Body mass index greater than 85 percentile for age and sex was seen in 36% of the children. No patient had bilateral TE identified. TEs were diagnosed based on epilepsy surgery conference re-review of imaging in 36% of cases. All herniations were contained defects without osseous dehiscence. Regional fluorodeoxyglucose (FDG) hypometabolism ipsilateral to the encephalocele was seen in all children who had FDG-positron emission tomography (PET) of the brain. Of the children who had surgery, 70% were seizure free or had nondisabling seizures at last follow-up (mean follow-up 52 months).

CONCLUSIONS:

TE is a surgically remediable etiology of DR-TLE in childhood. TEs are often overlooked at pediatric epilepsy diagnosis, calling for the need to increase awareness of this entity. FDG-PET temporal hypometabolism in children with presumed nonlesional DR-TLE should be carefully examined for occult TEs.

• Authors: Ersida Buraniqi, Julie B Guerin, Kai J Miller, Jamie J Van Gompel, Karl Krecke, Elaine C Wirrell, Katherine C Nickels, Eric T Payne, Lily Wong-Kisiel
• Journal: Pediatric neurology (Pediatr Neurol) Vol. 142 Pg. 32-38 (05 2023) ISSN: 1873-5150 [Electronic] United States
• PMID: 36898288 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Inc. All rights reserved.

Chemical References

• Fluorodeoxyglucose F18

Topics

• Adult
• Humans
• Child
• Adolescent
• Epilepsy, Temporal Lobe (diagnostic imaging, etiology, surgery)
• Encephalocele (etiology, complications)
• Fluorodeoxyglucose F18
• Temporal Lobe (surgery)
• Drug Resistant Epilepsy (diagnostic imaging, etiology, surgery)
• Epilepsy (complications)
• Magnetic Resonance Imaging (methods)
• Treatment Outcome