Clinical features and surgical outcome of medial temporal lobe epilepsy with a history of complex febrile convulsions.

Objective: Temporal lobe epilepsy (TLE) is frequently associated with hippocampal sclerosis (HS) and complex febrile convulsions (CFC). The causal relationship between TLE, HS, and CFC is unclear. There is also contradictory data whether CFC-associated TLE is a distinct epilepsy syndrome and has different surgical outcome than other medial TLEs.

Methods: We investigated 133 patients (aged 16-59 years) with HS-associated TLE. Thirty-six patients with CFC (CFC group) versus 97 patients without febrile convulsions (NFC group) were compared for clinical history, video-EEG recorded seizure semiology, and surgical outcome.

Results: In the CFC group the right-sided HS (67% versus 32%) occurred more frequently than in the NFC group (P<0.001). The two groups did not differ according to the clinical features, both groups share the typical symptoms and findings of the medial TLE. In the CFC group, seizure-freedom 2 years after surgery was 91%, while in the NFC group it was only 64% (P=0.023). This difference was significant even after considering the other known predictive factors for medial TLE.

Conclusions: Medial TLE with CFC is not a distinct epilepsy syndrome. The surgical outcome, however, is much more favorable in these patients in comparison with medial TLE patients who had no history of febrile convulsions.