This study aimed to compare long-term seizure outcomes and identify prognostic factors in pediatric (defined as children less than or equal to 12 years) and adult patients undergoing TLE surgery at a high-volume epilepsy center in South India

Temporal lobe epilepsy (TLE) is the most common focal epilepsy, with two-thirds of drug-resistant cases eligible for surgery. Although children often show better postoperative outcomes, comparative data between adults and children undergoing identical procedures over the same period remains limited, highlighting a gap in longitudinal surgical outcome research.

The study cohort comprised of 684 consecutive patients (127 children, 557 adults) who underwent standard anterior temporal lobectomy. All underwent presurgical evaluation including video EEG, neuroimaging, and surgical decision was made in a multidisciplinary meet. Seizure freedom was defined as ‘absence of seizures or auras regardless of antiepileptic drug use’, which was the primary outcome. The predictors determining outcome in both age groups were also analysed. Logistic regression identified the predictors, and Kaplan–Meier curves assessed long-term seizure-free survival.

Children had significantly shorter epilepsy duration pre-surgery (8.38 versus 19.2 years, p< 0.0001) and significantly better seizure outcome (57.4% vs 45.6%, p = 0.0165). Kaplan-Meier analysis revealed longer median seizure-free survival in children (120 months) than adults (72 months, p- 0.027). In adults, predictors of poor outcome included auditory aura, behavioral arrest, spike-wave discharges during ictal onset, and bitemporal IEDs. Febrile seizures predicted favorable outcome in children and adults. In children, neoplasia as a substrate was protective, while psychiatric co-morbidity and multiple auras predicted seizure recurrence.

Children benefit more from TLE surgery than adults, due to earlier intervention and shorter duration of seizures. The principle of 'time is brain' holds true in epilepsy; prolonged duration of uncontrolled seizures fosters network expansion, highlighting the need for ‘early surgical referral’ and ‘catching them young’