The temporal lobe is a common focus for epilepsy. Temporal lobe epilepsy in infants and children differs from the relatively homogeneous syndrome seen in adults in several important clinical and pathological ways. Seizure semiology varies by age, and the ictal EEG pattern may be less clear cut than what is seen in adults. Additionally, the occurrence of intractable seizures in the developing brain may impact neurocognitive function remote from the temporal area. While many children will respond favorably to medical therapy, those with focal imaging abnormalities including cortical dysplasia, hippocampal sclerosis, or low-grade tumors are likely to be intractable. Expedient workup and surgical intervention in these medically intractable cases are needed to maximize long-term developmental outcome. 1. Introduction The temporal lobe plays a vital role in epilepsy and is the most frequent lobe involved in focal onset seizures. Temporal lobe epilepsy in children and infants has clear clinical features which make it distinct from the fairly homogeneous syndrome seen in adults. Reported studies of temporal lobe epilepsy (TLE) in children are heavily biased towards those with medically intractable epilepsy, and few studies focus on cohorts who are newly diagnosed. This paper will address pediatric-specific aspects of TLE, including clinical semiology in young children, pediatric epilepsy syndromes involving the temporal lobe, medical and surgical management, associated psychiatric and cognitive disorders, and long-term outcomes. 2. Epidemiology The overall incidence of new-onset epilepsy in children ranges from 33 to 82 per 100,000 children per year, and approximately half- to two-thirds of these children have focal-onset seizures [1–6]. However, the exact incidence of TLE is not known, as the specific lobe of onset is not specified in most incidence studies. Compared to adults, focal seizures in children are more likely to arise from extratemporal foci. Simon Harvey et al. identified 63 children with new-onset TLE over a 4-year period in the state of Victoria, Australia (population 4.4 million) [7]. In our 30-year cohort of new-onset epilepsy in children, 276/468 (59%) had nonidiopathic focal epilepsy. Of these, 20 (7.2%) had a focal lesion on MRI in the temporal region (10: mesial temporal sclerosis, 1: malformation of cortical development, 2: ischemia/gliosis, 1: tumour, and 4: vascular malformation), while 17 (6.1%) had normal imaging and a single focus of epileptiform discharge in the temporal region. Therefore, it was determined that TLE was responsible
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