The pathological findings in surgical material from children with refractory epilepsy has not yet offered a clear understanding of its role in this condition. This article reports the results of a retrospective review of surgical specimens obtained from 80 children, ages 12 or younger, who underwent surgery for intractable epilepsy at Miami Children's Hospital between 1990 and 1996. Based on medical records of microscopic examination of the specimens at the time of excision, only one specimen was normal. The primary pathologies in the remaining 79 specimens were: ectopic neurons (3), dysplastic cells with ectopic neurons (2), dyslamination with large neurons (7), dyslamination with ectopic neurons (18), dyslamination with dysplastic cells (10), pachygyria with ectopic neurons (2), encephalomalacia (9), gliosis with ectopic neurons (10), gliosis without ectopic neurons (3), developmental ectodermal tumor (6), ganglioglioma (2), tumors (3), and Rasmussen encephalitis (4). Lesions were located in the temporal lobe in 34 children. Thus, extratemporal lesions were more frequent than temporal lesions, including hippocampal sclerosis. Ectopic neurons, the most frequent pathology, was found concomitant with other pathologies in 33 patients. It is possible that ectopic neurons are not a cause of seizures but rather an indication of other highly epileptogenic cortical malformations.
