INTRODUCTION The distribution of hippocampal sclerosis (HS) subtypes, according to the classification of the International League Against Epilepsy (ILAE), has been reported mainly in adult patients. We aimed to review the pathological findings in children who had anterior temporal lobectomy accompanied with amygdalohippocampectomy, in view of the current classification, and evaluate postsurgical outcome with respect to HS subtypes in childhood. METHODS Seventy children who underwent temporal resections for treatment of medically refractory epilepsy, with a minimum follow-up of 2 years, were included; the surgical hippocampus specimens were re-evaluated under the HS ILAE classification. RESULTS Neuropathological evaluations revealed HS type 1 in 38 patients (54.3%), HS type 2 in 2 (2.8%), HS type 3 in 21 patients (30%), and no HS in 9 patients (12.9%). Of 70 patients, 23 (32.9%) had dual pathology, and the most common pattern was HS type 3 with low-grade epilepsy-associated brain tumors (LEAT). The distribution of HS types with respect to age revealed that HS type 3 and no HS subgroups had significantly more patients younger than 12 years, compared with those of HS type 1 (90.5%, 77.8% vs 47.4%, respectively). History of febrile seizures was higher in HS type 1. Prolonged/recurrent febrile seizures were most common in patients 12 years and older, whereas LEAT was the most common etiology in patients under 12 years of age (p < 0.001). Patients with HS type 1 had longer duration of epilepsy and an older age at the time of surgery compared with patients with HS type 3 and no HS (p: 0.031, p: 0.007). At final visit, 74.3% of the patients were seizure-free. Seizure outcome showed no significant difference between pathological subtypes. CONCLUSIONS Our study presents the distribution of HS ILAE subtypes in an exclusively pediatric series along with long-term seizure outcome. The study reveals that the leading pathological HS subgroup in children is HS type 1, similar with adult series. Hippocampal sclerosis type 2 is significantly less in children compared with adults; however, HS type 3 emerges as the second most predominant group because of dual pathology, particularly LEAT. Further studies are required regarding clinicopathological features of isolated HS in pediatric cohort. Seizure-free outcome was favorable and similar in all HS types in children. The proportion of HS types may be better defined in pediatric patients with temporal resections, as the current HS ILAE classification becomes more widely used, and may help reveal the surgical and cognitive outcome with respect to HS types.

中文翻译：

---

儿童颞叶切除术后海马硬化的国际共识分类及病因多样性

引言 根据国际抗癫痫联盟 (ILAE) 的分类，海马硬化 (HS) 亚型的分布主要在成年患者中报道。鉴于目前的分类，我们旨在回顾前颞叶切除术伴杏仁海马切除术的儿童的病理结果，并评估儿童期 HS 亚型的术后结果。方法 70 名接受颞叶切除术治疗药物难治性癫痫的儿童，至少随访 2 年。在HS ILAE分类下重新评估手术海马标本。结果 神经病理学评估显示 38 名患者 (54.3%) 为 1 型，2 名 (2.8%) 为 2 型，21 名患者 (30%) 为 3 型，9 名患者 (12. 9%）。在 70 名患者中，23 名 (32.9%) 具有双重病理，最常见的模式是 HS 3 型低级别癫痫相关脑肿瘤 (LEAT)。HS 类型相对于年龄的分布显示，与 HS 1 型相比，HS 3 型和无 HS 亚组中 12 岁以下的患者明显更多（分别为 90.5%、77.8% 和 47.4%）。1 型 HS 的热性惊厥史更高。持续性/复发性热性惊厥在 12 岁及以上的患者中最常见，而 LEAT 是 12 岁以下患者中最常见的病因（p < 0.001）。与 HS 3 型和无 HS 患者相比，HS 1 型患者癫痫持续时间更长，手术时年龄更大（p：0.031，p：0.007）。在最后一次就诊时，74.3% 的患者没有癫痫发作。癫痫发作结果显示病理亚型之间没有显着差异。结论 我们的研究展示了 HS ILAE 亚型在一个专门的儿科系列中的分布以及长期癫痫发作结果。该研究表明，儿童主要病理性 HS 亚组是 1 型 HS，与成人系列相似。与成人相比，儿童的 2 型海马硬化显着减少；然而，由于双重病理，尤其是 LEAT，HS 3 型成为第二大主要组。需要进一步研究儿童队列中孤立性 HS 的临床病理特征。在所有 HS 类型的儿童中，无癫痫发作结果良好且相似。在颞叶切除的儿科患者中可能会更好地定义 HS 类型的比例，