Seizure recurrences after temporal lobe epilepsy surgery in childhood and adolescence: predictive factors, patterns of recurrence, and long-term outcomes.

BACKGROUND

Temporal lobe epilepsy (TLE) is the leading cause of drug-resistant focal epilepsy. Surgery is effective, yet many patients experience postoperative seizure recurrence.

OBJECTIVE

To identify predictors of recurrence and characterize recurrence patterns, treatment responses, and long-term outcomes using a 16-year surgical database.

METHODS

We retrospectively reviewed children and adolescents (0-19 years) with TLE who underwent resective or destructive temporal lobe surgery at Mayo Clinic, Rochester (2008-2024). All patients underwent scalp EEG phase I monitoring and 1.5T or 3T MRI, with invasive monitoring and advanced imaging studies utilized in selected patients when clinically indicated. Patients with prior epilepsy surgery, <1-year follow-up, or without research authorization were excluded. Data were analyzed using descriptive statistics, survival analysis, and Cox proportional hazard models. Seizure recurrence was categorized as acute post-operative seizures (APOS, ≤1 week post-surgery), early recurrence (>1 week-2 years), and late recurrence (>2 years). Delayed seizure freedom was defined as ≥1 year seizure-free before last follow-up after recurrence.

RESULTS

Among 61 patients, 34 (55.7%) had recurrence over a median follow-up of 49 months. Median time to first recurrence was 48 months. Four patients (6.5%) had APOS; all developed early recurrence. APOS predicted early recurrence (HR = 6.02, 95% CI = 1.64-22.04, p = 0.006). Delayed seizure freedom was achieved with medication trials in 19% (5/26) of early and 75% (6/8) of late recurrences. At last follow-up, 68% (42/61) were seizure free: 44% (27/61) since the first surgery and 24% (15/61) after recurrence.

CONCLUSION

Temporal lobe epilepsy surgery provides durable seizure control in two-thirds of pediatric and adolescent patients. APOS may predict early recurrence, which is often less medically responsive and may warrant repeat surgery.