Introduction

Temporal lobe epilepsy (TLE) is characterized by recurrent, unprovoked focal seizures originating in the temporal lobe of the brain, with clinical or electrographic correlates.

Method

Children aged <18 years with TLE between January 2016 and December 2017 in a tertiary care center in north India were retrospectively analyzed for clinical presentation, seizure semiology, radiological and electrographic correlates and response to antiepileptic drugs (AEDs).

Results

In 50 children with TLE (27 boys, median age of onset of 9 years, IQR: 7-12 years), predominant seizure semiology were focal onset nonmotor seizure with behavioral arrest (44%) and focal clonic seizures (30%). Median seizure frequency was 4/year (IQR-2-30/year), and duration was 3 minutes (IQR 1-5 minutes).  Prodromal aura (viscerosensory-32%), automatism (hyper motor -24%) and sleep potentiation were found in 50%, 28%, and 18% respectively.

Interictal EEG showed unilateral and bilateral temporal lobe discharges in 84% and 12% respectively. MRI brain was normal in 34(68%) children, out of which 10 children (20%) had unilateral temporal hypometabolism on PET. The commonest (14%) MRI brain abnormality was unilateral mesial temporal sclerosis.

At a median follow up of 9 months (IQR 6 -15 months), seizures were controlled with 1 and 2 AEDs (most common valproate and oxcarbamazepine) in 16(32%) and 18(36%) children respectively. Around one-third had pharmacoresistant epilepsy. Associated intellectual disability and behavioral issues were seen in 12(24%) and 8(16%) children respectively.

Conclusion

A correct electroclinical and neuroradiological approach is imperative for appropriate management of TLE.