Author(s) : Amit Ray, Prakash Kotagal , Department of Neurology, Fortis Hospital, Delhi, India, Section of Pediatric Epilepsy, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Summary : Temporal lobe epilepsy in children has been less well studied compared to that seen in adults. Whereas hippocampal sclerosis is the most common etiology for the adult temporal lobe epilepsy syndromes, tumors and malformations of cortical development are more commonly seen in children. Differences in seizure semiology are also apparent. Temporal lobe epilepsy in very young infants may exhibit prominent motor manifestations reminiscent of extra-temporal seizures. These motor manifestations however decrease with increasing age and are less abundant in adults. Automatisms, which are commonly seen in temporal lobe epilepsy in all age groups, are simple at a younger age and become increasingly more complex and discrete with age. Several case studies, illustrated on the video are included in this review. They highlight the differences in temporal lobe seizure semiology between children and adults. [Published with video sequences]
Figure 1 Coronal T1 image of brain MRI of patient
described in Case 1. Note the asymmetry between the two temporal
lobes. Left temporal lobe shows poorly defined sulcation pattern as
compared to the right, suggestive of cortical dysplasia.
Differential diagnoses included a low grade tumor in the left
temporal lobe.
Figure 2 Brain MRI (coronal TI image) of patient
described in Case 3 showing partial resection of the left temporal
lobe. The mesial left temporal lobe shows the remnants of the
tumor.
Figure 3A) Coronal T1 image of brain MRI of
Case 4. Note the poorly defined sulci in the right temporal lobe as
compared to the left. Differential diagnosis includes cortical
dysplasia versus a low grade tumor. B) Coronal T2 image of
brain MRI of Case 4. The right temporal lobe shows hypodensity
surrounded by an increased signal. Differential diagnoses include
low grade tumor versus cortical dysplasia.
Figure 4A) Brain MRI (coronal T1 image) of
Case 5. Note the cystic lesion in the left mesial temporal region
with the surrounding hypodensity and mass effect over the temporal
horn of the left lateral ventricle. Left temporal tumor is the
likely diagnosis. B) Coronal FLAIR image of Brain MRI of
Case 5. The cystic lesion in the left temporal region is seen again
surrounded by a hyperintense signal. The likely diagnosis is a
tumor in the left temporal region.
Figure 5A) Coronal TI image of brain MRI of
Case 6 showing smaller left hippocampus compared to the right. Also
note the increased size of the temporal horn of the left lateral
ventricle; a marker of volume loss in the left hippocampus.
B) Coronal T2 weighted images of brain MRI of patient
described in Case 6. The increased signal over the left mesial
temporal region is suggestive of left mesial temporal (hippocampal)
sclerosis.
Figure 6 Coronal FLAIR images of brain MRI of
patient described in Case 8. Increased signal is seen in the right
temporal region suggestive of possible malformation.
Figure 7A) Coronal FLAIR image of brain MRI
of patient described in Case 9. Note the increased signal in the
left temporal region, along with smaller temporal horn of the left
lateral ventricle. B) Coronal T1 images of Case 9 again
showing the asymmetry and mass effect on the left temporal horn,
along with poorer gray-white differentiation in the left temporal
lobe.
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