Cognitive profiles in pediatric unilobar vs. multilobar epilepsy

Moorhouse, Frederik Jan; Cornell, Sonia; Gerstl, Lucia; Wagner, Johanna; Tacke, Moritz; Roser, Timo; Heinen, Florian; Stülpnagel, Celina von; Vollmar, Christian; Kunz, Mathias; Ramantani, Georgia; Borggraefe, Ingo

doi:10.1016/j.ejpn.2022.09.006

Cited by 4 publications

(3 citation statements)

References 39 publications

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“…This is in line with findings that continuous seizure activity may have detrimental effects on cognitive networks [ 41 ]. In addition, lack of seizure freedom after epilepsy surgery may point to a more diffuse epileptogenic zone and lesion which might itself contribute to the interference with cognitive networks [ 42 ]. Lastly, seizure freedom after epilepsy surgery usually leads to ASM tapering, which has been associated with significant gains in total IQ [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis

Schmidlechner,

Zaddach,

Heinen

et al. 2023

J Neurol

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Objective This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. Methods A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. Results Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months–19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12–3.91). The pooled mean difference in DQ was + 1.47 (95% CI − 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI − 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. Significance The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis

Schmidlechner,

Zaddach,

Heinen

et al. 2023

J Neurol

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“…In particular, data on the effect of lesion-related features on intellectual skills as measured with intelligence tests or developmental tests in this patient group is so far sparse and inconsistent, 5,[8][9][10]12,17,18 in some cases stemming from historical cohorts assessed over 20 years ago. 8 Existing studies have drawn (1) on mixed pediatric and adult cohorts 5,17 ; (2) on specific pediatric age groups, such as infants and toddlers 12 or preschool children 9 ; (3) on specific etiologies such as cortical dysplasia 5,17 and low-grade tumors 19 ; and (4) on specific lobar localizations, such as frontal lobe epilepsies, 10 thus limiting the generalizability of their findings.…”

Section: Introductionmentioning

confidence: 96%

Lesion Extent Negatively Impacts Intellectual Skills in Pediatric Focal Epilepsy

Stefanos-Yakoub¹,

Kevin²,

Dorottya³

et al. 2023

SSRN Journal

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“…18,19,27 In young children, shortening the duration of epileptic encephalopathy (EE) is crucial for the resumption of cognitive development, whereas the expectation of developmental improvement following successful epilepsy surgery differs considerably depending on the presence of a developmental and epileptic encephalopathy (DEE). 28,29 Larger lesions 30,31 and a larger resection or disconnection extent have been associated with lower presurgical 22,[31][32][33][34] and postsurgical 16,32 intellectual functioning. However, the impact of epilepsy surgery on the change in intellectual functioning is yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

Long‐term intellectual and developmental outcomes after pediatric epilepsy surgery: A systematic review and meta‐analysis

Stefanos‐Yakoub,

Wingeier,

Held

et al. 2023

Epilepsia

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In addition to the primary aim of seizure freedom, a key secondary aim of pediatric epilepsy surgery is to stabilize and, potentially, optimize cognitive development. Although the efficacy of surgical treatment for seizure control has been established, the long‐term intellectual and developmental trajectories are yet to be delineated. We conducted a systematic review and meta‐analysis of studies reporting pre‐ and postsurgical intelligence or developmental quotients (IQ/DQ) of children with focal lesional epilepsy aged ≤18 years at epilepsy surgery and assessed at >2 years after surgery. We determined the IQ/DQ change and conducted a random‐effects meta‐analysis and meta‐regression to assess its determinants. We included 15 studies reporting on 341 patients. The weighted mean age at surgery was 7.1 years (range = .3–13.8). The weighted mean postsurgical follow‐up duration was 5.6 years (range = 2.7–12.8). The overall estimate of the mean presurgical IQ/DQ was 60 (95% confidence interval [CI] = 47–73), the postsurgical IQ/DQ was 61 (95% CI = 48–73), and the change was +.94 IQ/DQ (95% CI = −1.70 to 3.58, p = .486). Children with presurgical IQ/DQ ≥ 70 showed a tendency for higher gains than those with presurgical IQ/DQ < 70 (p = .059). Higher gains were determined by cessation of antiseizure medication (ASM; p = .041), not just seizure freedom. Our findings indicate, on average, stabilization of intellectual and developmental functioning at long‐term follow‐up after epilepsy surgery. Once seizure freedom has been achieved, ASM cessation enables the optimization of intellectual and developmental trajectories in affected children.

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Cognitive profiles in pediatric unilobar vs. multilobar epilepsy

Cited by 4 publications

References 39 publications

IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis

IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis

Lesion Extent Negatively Impacts Intellectual Skills in Pediatric Focal Epilepsy

Long‐term intellectual and developmental outcomes after pediatric epilepsy surgery: A systematic review and meta‐analysis

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