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Summary:Purpose: To investigate possible predictive factors for seizure control in a group of children and adults with low IQs (IQ, ≤70) who underwent resective surgery for intractable focal epilepsy and to study outcome with respect to seizures and neuropsychological functioning. We also studied psychosocial outcome in the adult patients.Methods: Thirty-one patients (eight children younger than 18 years) with a Wechsler Full Scale IQ of 70 or less underwent comprehensive neuropsychological assessments before and 2 years after surgery. Adults also completed the Washington Psychosocial Seizure Inventory (WPSI). Univariate analyses were used to identify variables differentiating between patients who became seizure free and those who did not. Pre-and postoperative test results were compared by t test for dependent samples.Results: Forty-eight percent of the patients became seizure free, 52% of those with temporal lobe resection and 38% of those with extratemporal resection. Only one variable was predictive for seizure outcome: duration of epilepsy. In one third of the patients, who had the shortest duration of epilepsy (<12 years), 80% became seizure free. Significant improvement was seen regarding vocational adjustment in adults (WPSI). Seizure-free adults improved their Full Scale IQ scores. No cognitive changes were found in seizure-free children or in patients who did not become seizure free. Conclusions: A good seizure outcome was obtained after resective surgery in patients with intractable focal epilepsy and low IQ, provided that treatment was done relatively shortly after onset of epilepsy. No adverse effects were seen on cognitive and psychosocial functioning.

The aim of this study was to compare the long-term consequences of refractory epileptic seizures for intellectual functioning in pediatric and adult patients, taking the severity of the epilepsy into consideration. Thirty-four patients, 17 children (mean age 10.2 years) and 17 adults (mean age 24.4 years) were tested twice with the age-appropriate version of Wechsler's Intelligence Scales. The mean test-retest interval in the two groups was 3.5 and 6.0 years, respectively. There were no statistically significant differences between the groups with respect to severity of the epilepsy at Test 1, as indicated by retrospective assessments of seizure severity, interictal EEG pathology, and number of antiepileptic drugs received per patient. Assessments of changes in these variables during the test-retest interval did not indicate different courses of the disease in the two groups. Despite these similarities, a statistically significant difference was found between the children and the adults regarding changes in intellectual functioning. In the children, there was a decline in mean intelligence quotient (IQ) scores during the test-retest interval, while the IQ scores increased in the adult group. It is concluded that recurrent seizures may represent a considerable risk for intellectual decline in children, while intellectual functioning seem to be less vulnerable in adults with early onset of epilepsy.

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Previously, only three studies with representative samples of patients with ruptured intracranial aneurysms have provided detailed results of prospective, repeated, neuropsychological assessments after surgery. These studies apparently disagree with regard to occurrence of cognitive deficits and to degree of improvement between early and delayed follow-ups. The present paper attempts to analyze the conditions underlying these differences in results. As a first step in this analysis we present a comprehensive, prospective, neuropsychological investigation of a consecutive sample of 41 patients with rupture of a supratentorial aneurysm, assessed 4 and 12 months after surgery. It is concluded that a prorated course of improvement of a wide specter of psychological functions may be revealed, but that sensitive tests and large samples are needed to establish the range of deficits and improvements with time. Differences in patient selection with respect to severity of the acute clinical state and delayed deterioration apparently contribute importantly to the discrepance in previously reported outcome.