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Neuropsychological outcomes following paediatric temporal lobe surgery for epilepsies: Evidence from a systematic
Alice E Flint1, Mitch Waterman2, Grace Bowmer3
1Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, United Kingdom; Paediatric Neuropsychology, E Floor, Martin Wing, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom.
Insights
This review of pediatric epilepsy surgery found that most children maintained stable neuropsychological function after temporal lobe resection, though some experienced deficits or improvements. Further research is needed to guide surgical decisions.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Neuropsychology
Background:
- Epilepsy surgery, specifically temporal lobe resection, is a treatment option for pediatric epilepsy.
- Neuropsychological outcomes following surgery are critical for evaluating treatment efficacy and quality of life.
Purpose of the Study:
- To systematically review neuropsychological outcomes in children undergoing temporal lobe resection for epilepsy.
- To investigate the impact of age at surgery and identify predictors of neuropsychological outcomes.
Main Methods:
- A systematic review of multiple electronic databases (MEDLINE, Embase, PsycINFO, etc.) was performed.
- Studies reporting neuropsychological outcomes specifically for temporal lobe resection in epilepsy patients were included.
Main Results:
- 73 studies were included, with most participants showing stable neuropsychological function post-surgery.
- Evidence suggests potential material-specific memory deficits related to resection side and better cognitive outcomes for those with lower pre-surgical ability.
Conclusions:
- Current evidence quality necessitates improvement in methodology and reporting standards.
- Prospective multicenter trials with long-term follow-up and standardized core outcome measures are recommended.
- Enhanced evidence will aid informed decision-making for clinicians, patients, and families regarding epilepsy surgery.
Objective:
The systematic review aimed to assess the neuropsychological outcomes of temporal lobe resections for epilepsy in children. Additional objectives included determining whether earlier age at surgery leads to better neuropsychological outcomes; the relationships between and predictors of these outcomes.
Methods:
Using advanced search terms, a systematic review of electronic databases was conducted, comprising MEDLINE, Embase, PsycINFO, Global Health, Web of Science and CINAHL. Included studies reported on outcome following neurosurgical treatment for epilepsy. Specifically, studies were included if they reported neuropsychological outcomes and were concerned only with temporal lobe resection.
Results:
73 studies met inclusion criteria. For reported neuropsychological outcomes, the majority of participants remained stable after surgery; some declined and some improved. There was some evidence for increased material-specific memory deficits after temporal lobe surgery based on resection side, and more positive cognitive outcome for those with lower pre-surgical ability level.
Significance:
Retrieved evidence highlights the need for improvements to quality of methodology and reporting. Appropriately designed prospective multicentre trials should be conducted with adequate follow-up for long-term outcomes to be measured. Core outcome measures should be agreed between centres. This would permit higher quality evidence so that clinicians, young people and their families may make better informed decisions about whether or not to proceed with surgery and likely post-operative profile.