Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery

Boshuisen, Kim; Schooneveld, Monique M.J. van; Uiterwaal, Cuno S.P.M.; Cross, J. Helen; Harrison, Sue; Polster, Tilman; Daehn, Marion; Djimjadi, Sarina; Yalnızoğlu, Dilek; Turanlı, Güzide; Sassen, Robert; Hoppe, Christian; Kuczaty, Stefan; Barba, Carmen; Kahane, Philippe; Schubert‐Bast, Susanne; Reuner, Gitta; Bast, Thomas; Strobl, Karl; Mayer, H.; Saint‐Martin, Anne de; Seegmüller, Caroline; Laurent, Agathe; Arzimanoglou, Alexis; Braun, Kees P.J.

doi:10.1002/ana.24427

Cited by 111 publications

(111 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast to previous studies, IQ change in this cohort was not significantly influenced by postsurgical cessation of seizures or AED treatment . The more limited postsurgical use of topiramate in the current sample may account for differences in relation to other cohorts (eg, Skirrow et al).…”

Section: Discussioncontrasting

confidence: 95%

Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study

et al. 2019

Self Cite

View full text Add to dashboard Cite

Summary Objective Intelligence quotient (IQ) outcomes after pediatric epilepsy surgery show significant individual variation. Clinical factors such as seizure cessation or antiepileptic medication discontinuation have been implicated, but do not fully account for the heterogeneity seen. Less is known about the impact of neurobiological factors, such as brain development and resection location. This study examines clinical and neuroimaging factors associated with cognitive outcome after epilepsy surgery in childhood. Methods Fifty‐two children (28 boys, 24 girls) were evaluated for epilepsy surgery and reassessed on average 7.7 years later. In the intervening time, 13 were treated pharmacologically and 39 underwent focal surgery (17 temporal, 16 extratemporal, six multilobar; mean age at surgery = 14.0 years). Pre‐ and postsurgical assessments included IQ tests and T1‐weighted brain images. Predictors of IQ change were investigated, including voxel‐based analyses of resection location, and gray and white matter volume change. Results Overall modest IQ improvement was seen in children treated surgically, but not in those treated pharmacologically only. Applying a ≥10‐point change threshold, 39% of the surgically treated children improved, whereas 10% declined. Clinical factors associated with IQ increases were lower preoperative IQ and longer follow‐up duration, whereas seizure and antiepileptic medication cessation were not predictive. Among neuroimaging factors, we observed that left anterior temporal resections impacted negatively on verbal reasoning, linked to full‐scale IQ decline. In contrast, gray matter volume change in ipsi‐ and contralesional hemispheres was positively correlated with IQ change. Voxel‐based morphometry identified the gray matter volume change in the contralesional dorsolateral frontal cortex as most strongly associated with IQ improvement. Significance We show that a variety of factors are likely to contribute to patterns of postsurgical change in IQ. Neuroimaging results indicate that left anterior temporal resections constrain development of verbal cognition, whereas simultaneously cortical growth after surgical treatment can support improvements in IQ.

show abstract

Section: Discussioncontrasting

confidence: 95%

Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] The decision to withdraw AEDs is partially based on an assessment of the risk of seizure recurrence. Being able to discontinue drugs is the ultimate proof of successful epilepsy surgery.…”

Section: Introductionmentioning

confidence: 99%

Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery

et al. 2018

Self Cite

View full text Add to dashboard Cite

The objective of this study was to create a clinically useful tool for individualized prediction of seizure outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. We used data from the European retrospective TimeToStop study, which included 766 children from 15 centers, to perform a proportional hazard regression analysis. The 2 outcome measures were seizure recurrence and seizure freedom in the last year of follow-up. Prognostic factors were identified through systematic review of the literature. The strongest predictors for each outcome were selected through backward selection, after which nomograms were created. The final models included 3 to 5 factors per model. Discrimination in terms of adjusted concordance statistic was 0.68 (95% confidence interval [CI] 0.67-0.69) for predicting seizure recurrence and 0.73 (95% CI 0.72-0.75) for predicting eventual seizure freedom. An online prediction tool is provided on www.epilepsypredictiontools.info/ttswithdrawal. The presented models can improve counseling of patients and parents regarding postoperative antiepileptic drug policies, by estimating individualized risks of seizure recurrence and eventual outcome.

show abstract

“…56 Studies in epilepsy surgery patients have demonstrated that AED withdrawal achieves incremental IQ gains. [58][59][60] In a recent, randomised, placebo-controlled, phase II, double-blind study in adolescents with uncontrolled focal-onset seizures (n=133), no statistically significant difference was reported for add-on perampanel versus placebo in Cognitive Drug Research global cognition score. 61 In this study, perampanel was increased weekly in 2-mg increments to 8-12 mg/day during 6-week titration and the maintenance phase lasted 13 weeks.…”

Section: Impact On Behavioural Change In Epilepsymentioning

confidence: 98%

Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence

Trinka¹,

Carreño²

2017

European Neurological Review

View full text Add to dashboard Cite

O ptimal epilepsy management includes five important elements: rational treatment selection, efficacy, off-target effects, adherence and interactions and dosing issues. Perampanel (2-[2-oxo-1-phenyl-5-pyridin-2-yl-1,2-dihydropyridin-3-yl]benzonitrile; E2007) is the first potent, selective, orally-active non-competitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist approved for the treatment of patients with epilepsy. Results from randomised controlled trials and real-world studies of refractory epilepsy populations treated with perampanel showed effective frequency reduction for both focal-onset seizures (without and with secondary generalisation) and for primary generalised tonic-clonic seizures. Perampanel therapeutic doses have been calculated to only inhibit a fraction of AMPA receptors, thereby to enable sufficient seizure control without substantial impairment of neurological function. Further investigation in special subpopulations of people with epilepsy, including the elderly and people with learning disability or psychiatric comorbidities, is warranted. With an average long half-life of 105 hours, perampanel may be more forgiving in circumstances of suboptimal adherence. Perampanel is not a strong inducer or inhibitor of cytochrome P450 enzymes, and dose adjustment is not always required for the elderly or for those with mild renal impairment.

show abstract

Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery

Abstract: Start of AED withdrawal, number of AEDs reduced, and complete AED withdrawal were associated with improved postoperative IQ scores and gain in IQ, independent of other determinants of cognitive outcome.

Cited by 111 publications

References 24 publications

Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study

Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study

Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery

Reflections on the Use of Perampanel in Epilepsy – Lessons from the Clinic and Real-world Evidence

Contact Info

Product

Resources

About