Cognitive outcome after epilepsy surgery in children: A controlled longitudinal study |
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| Institution: | 1. Pediatric Neurology Unit and Laboratories, Children''s Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy;2. Department of Neuroscience -University of Parma, Via Volturno 39, 43125, Parma, Italy;3. Pediatric Neurosurgery Unit, Children''s Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy;4. IRCCS Stella Maris, Viale del Tirreno 331, 56128 Calambrone Pisa, Italy;1. Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada;2. Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada;3. Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada;4. Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada;5. Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada;1. Department of Psychology, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada;2. Department of Psychology, University of Toronto Mississauga, Mississauga, Canada;3. Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, Canada;1. Department of Psychology, University of Sydney, Sydney, NSW, Australia;2. ARC Centre of Excellence in Cognition and Its Disorders, Australia;3. Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada;4. Neurosciences and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada;1. Sector of Neuropsychology for Children and Adolescents, Hp KG 01.327.1, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands;2. Bio Research Center for Children, Wekeromseweg 8, 6816 VS Arnhem, The Netherlands;3. Department of Child Neurology, Hp KC 03.063.0, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands;4. Department of Neurosurgery, Hp G 03.124, Brain Center Rudolf Magnus, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands;5. SEIN, Epilepsy Institute of the Netherlands Foundation, Location Meer en Bosch, P.O. Box 540, 2103 SW Heemstede, The Netherlands;6. Department of Behavioural Sciences, Kempenhaeghe Expertise Centre for Epileptology, Sleep Medicine and Neurocognition, P.O. Box 61, 5590 AB Heeze, The Netherlands;7. Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands;1. Department of Pediatrics, Pusan National University Children''s Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea;2. Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea;3. Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children''s Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea;4. Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;5. Department of Pediatric Neurosurgery, Severance Children''s Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea |
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| Abstract: | ObjectiveTo analyze the determinants of cognitive outcome two years after surgery for drug-resistant epilepsy in a cohort of 31 children when compared to a control group of 14 surgical candidates who had yet to undergo surgery two years after the first neuropsychological assessment.MethodsControlled longitudinal study including three evaluations of IQ (Intelligence Quotient) scores or GDQ (General Developmental Quotient) for each group depending on the patient's age: prior to surgery (T0), one year (T1) and two years (T2) after surgery for the surgical group; baseline (T0) and one year (T1) and 2 years (T2) after the first evaluation for the control-group. At follow-up, 25 children (80%) of the surgical group were seizure free, while seizure outcome was unsatisfactory in the remaining six (20%).To analyze language, visuomotor skills, memory, reading, visual attention, and behavior, we selected 11 school age children in the surgical group and nine controls. We reported performance prior to (T0) and one year after surgery (T1).ResultsThere was a significant correlation between earlier age at seizure onset and lower IQ/GDQ at T0 (r = 0.39; p = 0.03) in the overall cohort. IQ/GDQ scores did not significantly differ between the surgical and control groups when analyzed at T0 and T2. However, they evolved differently with an improved developmental trajectory becoming identifiable only in the surgical group (F1,31 = 5.33 p = 0.028; η2 = 0.15). There was also a significant increase of forward digit span (Z = 2.33; p = 0.02) and Rey recall scores (Z = 1.97; p = 0.049) in the surgical school age subgroup at T1 versus T0.SignificanceWe identified significantly different developmental trajectories in operated versus non- operated children with improved IQ/GDQ scores in operated children only. We also observed a significant increase of digit span scores and Rey recall scores a year after surgery. Further studies including larger samples with longer follow-ups are needed to confirm these preliminary findings. |
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