A community-based cohort of 77 children with new-onset temporal lobe epilepsy (TLE) were followed prospectively and reviewed at 7 and 14 years after seizure onset, and clinical, EEG, and neuroimaging findings and seizure outcome are reported from the Royal Children's Hospital and University of Melbourne, Australia, and Starship Children's Hospital, Auckland, New Zealand. Age at follow-up was a median of 20 years (range, 12 to 29 years), and the median follow-up period was 13.7 years. Of 62 patients completing the study, 19 (30%) were seizure free and off treatment, with no seizures for 5 to 15 years, while 43 had ongoing seizures or were treated surgically. MRI lesions identified in 28 patients with seizures included hippocampal sclerosis in 10, tumor in 8, and cortical dysplasia in 7. Focal slowing on the EEG was also associated with persistent seizures. Twenty one (75%) patients with positive neuroimaging studies underwent surgery, and 67% became seizure-free. Factors not predictive of seizure outcome included infantile onset and family history of epilepsy. 
COMMENT. Spontaneous remission of seizures occurs in one-third of patients with new-onset TLE. A lesion on MRI and focal slowing on EEG are predictive of refractory seizures and the need for surgical resection. Whereas 67% of TLE patients having MRI lesions became seizure free after surgical resection, only 53% of patients with negative neuroimaging became seizure free with medication alone, at 10 or more year follow-up . Repeat neuroimaging may uncover developing lesions in 14% of patients with TLE, and prompt surgical evaluation and treatment.