Surgery of children with frontal lobe lesional epilepsy: Neuropsychological study

Chieffo, Daniela Pia Rosaria; Lettori, Donatella; Contaldo, Ilaria; Perrino, Francesca; Graziano, Alessandra; Palermo, Concetta; Mittica, A.; Tamburrini, Giampiero; Battaglia, Domenica; Rocco, Concezio Di; Guzzetta, Andrea

doi:10.1016/j.braindev.2010.06.006

Cited by 25 publications

(14 citation statements)

References 35 publications

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“…Speech arrest and hesitations in this area are associated more with a speech-motor function than a frontal language function. This is consistent with visual naming deficits being relatively rare in frontal lobe epilepsy pediatric patients [35] and the location of visual naming errors during cortical stimulation found more superiorly in the MFG [4], likely as a result of terminations of the arcuate fasciculus, which is implicated in various aspects of language [25,36]. Together, these visual naming delays point to a speech-motor function with an earlier developmental profile and away from age-related functional changes.…”

Section: Results and Discussion—case Reportsupporting

confidence: 85%

“…Prior to the first surgical resection, declines in VCI, PSI, WMI, and FSIQ were seen, which is consistent with profiles seen in frontal lobe pediatric epilepsy studies [35,37,38,39]. The wide range of cognitive impairment prior to surgical intervention may be the result of rapid propagation of epileptic discharges both inter- and intra-hemispherically [38] or from subcortical abnormalities that prevent efficient communication between cortical areas [40].…”

Section: Results and Discussion—case Reportsupporting

confidence: 57%

“…Following surgical interventions, declines continued in auditory attention, visual memory, and executive functions. Executive functions such as planning, attention, organization, and motor coordination, as well as visuo-spatial attention and visuomotor integration, which are all mediated by the frontal lobe, have been known to decline following surgical intervention in lesional frontal lobe pediatric patients [35], potentially resulting from a combination of both cortical and subcortical resections.…”

Section: Results and Discussion—case Reportmentioning

confidence: 99%

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Reorganization and Stability for Motor and Language Areas Using Cortical Stimulation: Case Example and Review of the Literature

et al. 2013

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The cerebral organization of language in epilepsy patients has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping and more recently with noninvasive neuroimaging techniques, such as functional MRI. In the setting of a chronic seizure disorder, clinical variables have been shown to contribute to cerebral language reorganization underscoring the need for language lateralization and localization procedures. We present a 14-year-old pediatric patient with a refractory epilepsy disorder who underwent two neurosurgical resections of a left frontal epileptic focus separated by a year. He was mapped extraoperatively through a subdural grid using cortical stimulation to preserve motor and language functions. The clinical history and extensive workup prior to surgery is discussed as well as the opportunity to compare the cortical maps for language, motor, and sensory function before each resection. Reorganization in cortical tongue sensory areas was seen concomitant with a new zone of ictal and interictal activity in the previous tongue sensory area. Detailed neuropsychological data is presented before and after any surgical intervention to hypothesize about the extent of reorganization between epochs. We conclude that intrahemispheric cortical plasticity does occur following frontal lobe resective surgery in a teenager with medically refractory seizures.

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Section: Results and Discussion—case Reportsupporting

confidence: 85%

Section: Results and Discussion—case Reportsupporting

confidence: 57%

Section: Results and Discussion—case Reportmentioning

confidence: 99%

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Reorganization and Stability for Motor and Language Areas Using Cortical Stimulation: Case Example and Review of the Literature

et al. 2013

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“…Outcome studies have yielded such varied results as 1) improved cognitive outcomes; 3,8,19,34 2) slight improvement in cognition being more likely than decline, with significant declines in some children; 37 3) reversible decline in at least some children, especially following left temporal lobectomy; 7 4) lack of improved outcome, with some cognitive recovery being a "bonus"; 28 5) "stabilized developmental velocity"; 6 6) no improvement in outcome postsurgery, 2,30 with this lack of improvement theorized to be associated with an abnormal neural substrate versus seizures per se; 30 and 7) no improvement, with the possibility of decline in some cases. 1 Although methodological issues are beginning to be addressed in adolescents and adults, 4 they have not been addressed to the same extent in children, particularly very young children. Generally, the pediatric surgical outcome literature has been muddied by heterogeneous samples, combining many factors, including 1) markedly different surgical therapies, from focal resections to hemispherectomies; 3,26,28 2) broad age inclusion criteria, at different developmental levels, from 6 to 17 or 18 years 30,37 or 1 to 15 years 1 or "all children"; 2 3) variable levels of functioning prior to resection; 30 4) wide ranges of presurgical seizure duration; 28 and 5) variable pathologies.…”

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confidence: 99%

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

Shurtleff

Barry

Firman

et al. 2015

PED

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OBJECT 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

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“…For example a recent case series suggested little change or even worsening of cognitive function in a group of children undergoing surgery for frontal lobe epilepsy, despite good seizure outcomes. 14 Another small paediatric series (25 children), where more than half had extratemporal surgery, reported rates of psychiatric disorder of 71%. 15 However, in our case series, children with extratemporal epilepsy have overall lower rates of psychiatric disorder (52% with a psychiatric diagnosis) than the sample we have reported on previously with temporal lobe epilepsy (83% with a psychiatric diagnosis), who were assessed and treated in the same epilepsy surgery programme.…”

Section: Discussionmentioning

confidence: 99%

Psychopathology in children before and after surgery for extratemporal lobe epilepsy

Colonnelli

Cross

Davies

et al. 2012

Develop Med Child Neuro

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ADHD Attention-deficit-hyperactivity disorder ASD Autism spectrum disorder DBD(NOS) disruptive disorders not otherwise specified DSM-IV Diagnostic and Statistical Manual of Mental Disorders (4th edition) ODD ⁄ CD oppositional defiant disorder/conduct disorder AIM To establish the rates and types of psychiatric disorder in children before and after surgery for extratemporal epilepsy. Relationships between psychiatric morbidity and demographic ⁄ clinical variables were examined.METHOD A retrospective case note review of 71 children undergoing extratemporal focal resection for drug resistant epilepsy in a specialist epilepsy surgery programme between 1997 and 2008. Psychiatric diagnoses were derived from pre-and postoperative assessments according to DSM-IV criteria.RESULTS Seventy-one children (38 males, 33 females) were eligible for this study. Mean age (SD)at surgery was 9 (5) years. Frontal resections were performed in 73% of the children, parietal in 17%, and occipital in 10%. Mental health problems were present in 37 of 71 (52%) children preand ⁄ or postoperatively. A similar proportion of children had psychiatric diagnoses pre-and postoperatively: 31 of 71 (44%) and 32 of 71 (45%) respectively.INTERPRETATION Psychopathology is common in children with extratemporal epilepsy. In this sample, the impact of surgery on psychiatric symptoms was not predictable: some children were unchanged, others improved, and others acquired new psychiatric diagnoses postoperatively. Given the high rates of psychiatric disorder in this group of patients, detection and treatment of mental health needs may be important.Children with epilepsy have higher rates of psychiatric disorders than children in the general population. For example, in one epidemiological study, 29% of children with epilepsy had at least one psychiatric diagnosis, more than four times the rate in the general population. This compared with 11.6% in children with chronic physical disorders not involving the brain. 1 Psychiatric diagnoses were found in 58% of children with additional neurological problems as well as epilepsy, a finding replicated in other epidemiological samples.2 Children entering epilepsy surgery programmes are usually examples of this latter group; they almost always have a structural brain abnormality and complex epilepsy, and are, therefore, likely to have high rates of psychiatric disorder. In addition, studies of clinical samples have indicated that the psychosocial impairments in these children are significantly greater than those found in children with other chronic disorders such as diabetes or asthma 3,4 and that mental health problems contribute significantly to the overall impairment experienced by the child and family. 5The best-studied group of patients undergoing epilepsy surgery are those with temporal lobe epilepsy. In children who have undergone temporal lobe resections for epilepsy refractory to medical treatment, a previous study from our group showed that psychopathology was common and a wide range of disorders were seen, in...

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Surgery of children with frontal lobe lesional epilepsy: Neuropsychological study

Cited by 25 publications

References 35 publications

Reorganization and Stability for Motor and Language Areas Using Cortical Stimulation: Case Example and Review of the Literature

Reorganization and Stability for Motor and Language Areas Using Cortical Stimulation: Case Example and Review of the Literature

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

Psychopathology in children before and after surgery for extratemporal lobe epilepsy

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