Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Outcomes of focal resection in young children with early-onset epilepsy are varied in the literature due to study differences. In this paper, the authors sought to define the effect of focal resection in a small homogeneous sample of children who were otherwise cognitively intact, but who required early surgical treatment. Preservation of and age-appropriate development of intelligence following focal resection was hypothesized.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Cognitive outcome after focal resection was retrospectively reviewed for 15 cognitively intact children who were operated on at the ages of 2–6 years for lesion-related, early-onset epilepsy. Intelligence was tested prior to and after surgery. Effect sizes and confidence intervals for means and standard deviations were used to infer changes and differences in intelligence between 1) groups (pre vs post), 2) left versus right hemisphere resections, and 3) short versus long duration of seizures prior to resection.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>No group changes from baseline occurred in Full Scale, verbal, or nonverbal IQ. No change from baseline intelligence occurred in children who underwent left or right hemisphere surgery, including no group effect on verbal scores following surgery in the dominant hemisphere. Patients with seizure durations of less than 6 months prior to resection showed improvement from their presurgical baseline in contrast to those with seizure duration of greater than 6 months prior to surgery, particularly in Wechsler Full Scale IQ and nonverbal intelligence.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>This study suggests that surgical treatment of focal seizures in cognitively intact preschool children is likely to result in seizure remediation, antiepileptic drug discontinuation, and no significant decrement in intelligence. The latter finding is particularly significant in light of the longstanding concern associated with performing resections in the language-dominant hemisphere. Importantly, shorter seizure duration prior to resection can result in improved cognitive outcome, suggesting that surgery for this population should occur sooner to help improve intelligence outcomes.</jats:p></jats:sec>

Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web‐based survey by the ILAE Task Force on Pediatric Epilepsy Surgery

“…Pediatric epilepsy surgery has been performed with increasing frequency over the last 30 years in a growing target population . This is related to increased public awareness that surgical treatment is possible, improved recognition of candidates for surgery, the wider availability of investigational tools (especially magnetic resonance imaging [MRI] and video–electroencephalography [EEG]), improvement in surgical techniques, and the appreciation that seizure cessation for some children may impact positively on cognitive and behavioral development …”

Neuropsychology's Role in Pediatric Epilepsy Surgery

“…31 It is well accepted that earlier versus later seizure cessation is necessary for better versus worse neurocognitive outcome. 4,113 Age is also associated with differences in epilepsy disorders, with very early onset epilepsy considered to be associated with worse disease. • Plasticity is an important concept to consider with pediatric epilepsy, but should be considered particularly in the context of specialization of function and patient age.…”

“…1 Surgical treatment has continued to this day, when surgery is a well-accepted method of treatment, for adults and children. [2][3][4][5] Epilepsy surgery is currently considered safer and more efficacious, as compared with antiepileptic drugs, for some epilepsy types. 6,7 Correspondingly, studies of cognition have informed epilepsy treatments since the late 19th and early 20th century 8 and have been a part of epilepsy surgery work-ups for decades.…”

Epilepsy surgery in low- and middle-income countries: A scoping review

“…Over the last decades various epilepsy surgery techniques have evolved to become major treatment options, but they are underutilized [7]. The benefits of these surgeries outweigh the associated risks in achieving seizure freedom, improving quality of life and reducing mortality [8][9][10][11][12][13][14][15][16][17]; with about 60% of those who had temporal lobe resective surgery remaining seizure-free in the long-term [18,19].…”