MMR indicates measles, mumps, and rubella. Vertical dashed line represents the overall rate ratio (RR) for febrile seizures within the 2 weeks following MMR vaccination compared with nonvaccinated children. Point estimates are given with error bars representing 95% confidence intervals.
*The RRs are adjusted for age and calendar period. The analyses including siblings were additionally adjusted for the total number of siblings. Children with missing values were excluded when the effect of the variable concerned was evaluated.
Test for interaction was performed by a test for trend. When evaluating the possible effect modification by siblings with febrile seizures or by siblings with epilepsy, children without siblings were not included in the test for interaction.

Figure (facing page). The temporal lobes have memory, emotional, auditory, olfactory, and higher visual functions. They consist of a phylogenetically older medial portion and a newer, lateral portion. Seizures arising in either region cause auras (simple partial seizures) that often progress to impaired consciousness with oral and hand automatisms. Medial (limbic) areas often cause abdominal sensations and fear while lateral (neocortical seizures) often cause déjà vu, dreamy state, abdominal sensation, tinnitus, and vertigo.
Top panel, position of imaging planes A and B in middle and bottom panels. Left, three-quarter view of the brain showing the hippocampus and adjacent structures. Right, midsagittal section showing the medial surface of the left hemisphere (brainstem removed) and structures deep to the plane of section.
Middle panel, Mesial temporal sclerosis (MTS). Left, a magnetic resonance image (MRI) of a patient with MTS; arrowhead indicates atrophic left hippocampus. Mesial temporal sclerosis is associated with a history of febrile seizures, especially prolonged ones. Right, anatomic structures in this coronal view and enlargement of detail from MRI showing atrophic left hippocampus.
Bottom panel, neocortical dysplasia. Left, inversion recovery image showing coronal view of the anterior temporal lobes in a patient with neocortical dysplasia (a malformation of cortical development) involving the left anterior temporal neocortex (temporal pole). Note thickening of the cortex (arrowhead), abnormal architecture, loss of differentiation between gray and white matter, and paucity of white matter. Lesions of the left temporal pole impair retrieval of unique names of places, persons, and objects. Right, anatomic structures in this coronal view.

Comparison of Monte Carlo model predictions for the 5-, 10-, 15-, and 20-year likelihoods of being free of seizures after surgery (solid line with mean and 95% confidence intervals) with the published 5- and 10-year likelihoods (dashed line to display the lowest and highest reported means) of being seizure free after surgery including studies that could not be used in our meta-analysis.^32-33,35

Three-dimensional cortical reconstruction from high resolution T1-weighted magnetic resonance imaging scans of Ms H identifying regions of interest (boldface) involved in frontal lobe seizures (note: insula is not shown).

A, Each line represents the quality-adjusted life-years (QALYs) associated with surgery (solid line) or with medical management (dashed line) for 35-year-old patients varying the surgical mortality rate from 0% to 80%. For any particular surgical mortality rate, the higher line is the preferred treatment of choice. The dot indicates the base-case value (0.3%), and the dotted vertical line indicates the threshold (24%) at which temporal lobe resection and medical management are equivalent. Anterior temporal lobe resection is preferred for probabilities below the threshold, and medical management for probabilities above the threshold. B, As the standardized mortality ratio (SMR) of patients with seizures on medical management increases, the benefit of surgery increases. The threshold is 2.3 (base-case, 5.4). Temporal lobe resection is preferred for SMR values above the threshold. C, As the annual probability of becoming seizure free with medical management increases, the benefit of surgery decreases. The threshold is 79% (base-case, 4.7%). Temporal lobe resection is preferred for probabilities below the threshold. D, As the quality of life without seizures following surgery decreases, the benefit of surgery decreases. The threshold is 0.58 (base-case, 0.97). Temporal lobe resection is preferred for values above this threshold. Note that at 0.58, the quality of life with medical management and seizures would be better (0.75) than being seizure free after surgery. E, As the quality of life with disabling seizure after anterior temporal lobe resection decreases, the benefit of surgery decreases. The threshold is 0.30 (base-case, 0.78). Temporal lobe resection is preferred for values above this threshold. Note that this values fall outside of the 95% confidence interval [CI] for patients who have received surgery (0.41-1.0).

A, Slow-wave activity (theta and delta) in the left temporal and central and right central areas is suggestive of localized cortical injury. The rare left temporal interictal epileptiform discharges are suggestive of an area of cortical irritability. B, Herald spike is the first physiological sign that a seizure is coming (appeared before every seizure); seizure onset is noted by reviewing the video recording linked to the EEG; pushbutton is an electrical artifact put on the EEG recording that marks the moment noted either by the patient or a family member that a clinical seizure has started.

MMR indicates measles, mumps, and rubella. Rate ratios are adjusted for age and calendar period. Point estimates are given with error bars representing 95% confidence intervals.

Reproduction of a hand-written concept map of seizures by a first-year resident. Note the absence of cross-links and the consistent use of 2 to 3 levels of hierarchy, resulting in a low score.

Reproduction of a hand-written concept map of seizures by a resident in the second- and third-year group. Note the complexity of the map as manifested by frequent cross-links and the consistent use of 5 to 7 levels of hierarchy, resulting in a higher map score.

These studies had a higher proportion of patients with death or permanent end-stage renal disease (ESRD) at follow-up, explaining 44% of the between-study variability (P = .01). The area of each circle is proportional to the number of patients in each study. Curve is best-fit line from meta-regression. See "Methods" section.

CT indicates computed tomography; MRI, magnetic resonance imaging.
*Patients with a neuroimaging report containing a keyword suggestive of stroke, or who carried a physician diagnosis of stroke, cerebral palsy, neonatal seizures, or a related diagnosis.

The square on the left represents a decision node, representing the choice between surgery and medical management. The circle is a chance node, representing various possible outcomes after surgery including procedure-related operative death, permanent long-term surgical complication, transient short-term surgical complication, or no surgical complication. The brace signifies a subtree that occurs for all branches leading to that brace. Each subtree enters a Markov process, leading to 1 of 3 health states (disabling seizures, seizure free, or dead). The Markov cycle represents time as a single year during which the health state may change. At the end of each branch is a terminal node that indicates the health state in which patients will begin the next 1-year cycle. The probability estimates from the literature in Table 1 determine the likelihood of the chance events.

*Cincinnati Prehospital Stroke Scale (CPSS); facial droop, arm drift, and abnormal speech.
Los Angeles Prehospital Stroke Scale (LAPSS); history (age >45 years, no history of seizures, symptoms <24 h, not wheelchair bound), blood glucose 60-400 mg/dL (3.3-22 mmol/L), and examination showing unilateral facial weakness, grip weakness, and arm weakness.

*The most common reasons for screening failures included a clinically significant medical condition, active hepatitis (aspartate transaminase [AST] or alanine transaminase [ALT] >3 times the upper limit of normal), failure to meet an average of 2 episodes of heavy drinking per week for the 30 days before randomization, and clinically significant psychiatric disease.
Enrollment failures due to investigator judgment were from seizure; an ongoing unresolved, unstable medical condition; and planned surgery to include opiate analgesia.

A, Mesial temporal sclerosis (arrowhead). T2-weighted sequence (TR SE 4500, TE 140 1/1). The hippocampus on the left is smaller and has increased T2 signal, evidence of atrophy and gliosis, respectively. The temporal horn of the lateral ventricle is larger on the left. Note also the blurring of the gray-white margin in the parahippocampal gyrus and inferior temporal gyrus. B, Low-grade tumor. T2-weighted sequence (TR 5560, TE 96). Note the mass inferior to the right hippocampus (arrowhead), with associated edema. This patient underwent a right anterior temporal lobectomy and is seizure-free postoperatively. Pathologic examination revealed a pilocytic astrocytoma. C, Cavernous angioma (arrowhead). T1-weighted sequence (TR 400, TE 9) after the administration of gadolinium-diethylenetriaminepentaacetic acid. D, Right frontal lobe traumatic contusion (arrowhead). T1-weighted sequence (FLAIR sequence: TR 6000, TE 150, TI 1900).