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Baldauf CM, Cukiert A, Burattini JA, Mariani PP, Camara RB, Seda L, Argentoni-Baldochi M, Baise-Zung C, Forster CR, Mello VA.
Department of Neurology and Neurosurgery, Epilepsy Surgery Program, Hospital Brigadeiro and Clinica de Epilepsia de Sao Paulo, Sao Paulo SP, Brazil
Rationale: The occurrence of febrile seizures in patients who would later develop refractory temporal lobe epilepsy has often been noted. Although the causal relationship of these events to the development of refractory epilepsy has been extensively discussed, no consensus has been reached. We studied the prevalence of febrile seizures and its relation to the surgical outcome in a homogeneous series of patients with unilateral mesial temporal sclerosis submitted to surgery.
Methods: Forty one patients with refractory unilateral temporal lobe epilepsy were studied. The presence or not of early febrile seizures was documented in all of them. MRI disclosed unilateral mesial temporal sclerosis (MTS) in all patients. All patients were submitted to cortico-amygdalo-hippocampectomy at the side determined by MRI.
Results: Febrile seizures occurred in 10 patients (24,39%). Non-febrile seizures started 7,619,25 years afterwards in these patients. There was no statistically significant relationship between the presence of febrile seizures and the age of onset of non-febrile seizures. Additionally, there was no statistical difference regarding neurophysiologic or surgical outcome findings in patients with or without febrile seizures. Overall, interictal EEG showed unilateral epileptiform discharges compatible with MRI findings in 37 patients; in four out of the 41 patients, bilateral discharges were found. Mean follow-up time was 4.3+1.1 years. Thirty-nine patients (95, 1%) were classified as Engel’s Class I (70,6% Engel I-A). Two patients (4.9%) were rated as Engel's Class II. All patients in whom bilateral discharges were found were in Engel’s Class I. Pathological examination showed mesial temporal sclerosis in all patients.
Discussion: Although frequently recognized during the initial clinical work-up of patients with refractory temporal lobe epilepsy, the presence of febrile seizures does not seem to be an important predisposing or prognostic issue in patients with mesial temporal sclerosis.