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Neuropediatrics 2010; 41(4): 167-175
DOI: 10.1055/s-0030-1267919
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Heterotopia Associated with Hippocampal Sclerosis: An Under-Recognized Cause of Early Onset Epilepsy in Children Operated on for Temporal Lobe Epilepsy

E. López H.1 , M. Fohlen2 , A. Lelouch-Tubiana3 , O. Robain3 , C. Jalin2 , C. Bulteau2 , G. Dorfmüller2 , O. Dulac3 , O. Delalande2
  • 1Hôpital Robert Debré, APHP – Unité de Neurophysiologie – Service Explorations Fonctionnelles, Paris, France
  • 2Fondation Rothschild – Unité de Neurochirurgie pédiatrique, Paris, France
  • 3Hôpital Necker-Enfants Malades, APHP – Laboratoire d’Anatomo-pathologie, Paris, France
Further Information

Publication History

received 25.05.2010

accepted 28.09.2010

Publication Date:
17 November 2010 (online)

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Abstract

Purpose: The aim of this study is to report on 52 children operated on for pharmacoresistant temporal lobe epilepsy, with special emphasis on histopathology and correlation with clinical features.

Methods: Charts were retrospectively analyzed. All children underwent comprehensive clinical, electrophysiological and radiological investigations before surgery. Surgical procedures were tailored according to scalp, foramen ovale and eventually depth electrode recordings. Histopathology was compared with clinical variables (χ2 and Fisher's exact tests). Outcome was evaluated using the Engel scale.

Results: Developmental tumor was found in 14 cases, malformation of cortical development (MCD) in 26, isolated hippocampal sclerosis (HS) in 5 and gliosis in 7. Dual pathology (DP) affected 18 patients and the main extrahippocampal lesion consisted of microscopic sub-cortical heterotopias (HS-HT) for 15 patients who shared a particular clinical pattern: a history of febrile seizures (FS) and/or brain injury, early onset of epilepsy without latent period from FS to the first temporal seizure, and a particularly good outcome following surgery.

Conclusion: In our pediatric temporal lobe surgery series, the prevalence for MCD and for DP was higher than in adult series. Age at seizure onset depends on pathology, and is earlier when involving the neocortex rather than only the hippocampus. We identify the association HS-HT (the most frequent DP in this series), with particular clinical features.

Key words

brain injury - febrile seizure - heterotopias - hippocampal sclerosis

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Correspondence

Elisa López H.

Hôpital Robert Debré

APHP – Explorations

Fonctionnelles

48 Bd Serrurier

75019 Paris

France

Phone: +33/06/1319 0275

Fax: +33/1/4003 4770

Email: elisa.lopez@rdb.aphp.fr

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