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Increase in cognitive function is seen in many single-operated pediatric patients after epilepsy surgery
Victoria Elizabeth de Knegt1, Christina Engel Hoei-Hansen1, Marianne Knudsen1
1Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Pediatric epilepsy surgery can improve intelligence quotient (IQ) in single-operated children. High preoperative seizure frequency predicts decreased IQ, highlighting surgery
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Neuroscience
Background:
- Recurrent seizures in pediatric drug-resistant epilepsy (DRE) negatively impact brain development and cognitive function.
- Epilepsy surgery is an increasingly utilized treatment for DRE in children.
- Understanding cognitive outcomes and predictors of change after surgery is crucial for patient management.
Purpose of the Study:
- To investigate pre- and postoperative cognitive function in pediatric epilepsy surgery patients.
- To identify predictive determinants of intelligence quotient (IQ) change following surgery.
Main Methods:
- A cohort of 91 Danish children undergoing focal resective epilepsy surgery (1996-2016) was analyzed.
- Patients underwent preoperative cognitive evaluations, with 1- and 2-year postoperative follow-ups.
- Cognitive outcomes were compared between single-operated and multi-operated patient groups.
Main Results:
- Single-operated patients (79/91) showed a significant postoperative increase in IQ (mean change: 3.3 ± 14.0).
- High preoperative seizure frequency was a significant predictor of decreased IQ post-surgery.
- Multi-operated patients did not experience IQ changes, though surgery improved seizure control.
Conclusions:
- Epilepsy surgery can lead to IQ gains, particularly in single-operated pediatric patients.
- Preoperative seizure frequency is a key predictor of cognitive outcomes after epilepsy surgery.
- Further research, including non-surgical controls, is needed to fully elucidate surgery's cognitive benefits.
Purpose:
The recurrent seizures of pediatric drug-resistant epilepsy (DRE) are known to impair brain development and can lead to a loss in cognitive functioning. Surgery is increasingly being used to treat children with DRE. This study investigates the pre- and postoperative cognitive function in a pediatric epilepsy surgery cohort as well as predictive determinants of change in intelligence quotient (IQ) following surgery.
Methods:
A consecutive series of 91 Danish children who underwent focal resective epilepsy surgery between January 1996 and December 2016 were included. All underwent preoperative cognitive evaluation and were reevaluated at 1-year and/or 2-year follow-up. Single-operated and multi-operated patients were examined separately.
Results:
79 of 91 patients were single-operated. Single-operated patients received less anti-epileptic drugs (AED) and experienced a decrease in seizure frequency postoperatively, p < 0.001. IQ increased postoperatively (IQ change ± standard deviation: 3.3 ± 14.0), p < 0.05. High preoperative seizure frequency was a significant predictor for decreased IQ, p < 0.01. Multi-operated patients did not experience a reduction in AED treatment. Surgery and continued AED treatment did, however, result in significantly better seizure control, p < 0.01. IQ remained unchanged in multi-operated patients.
Conclusion:
Epilepsy surgery allowed for IQ gains in single-operated patients. Preoperative seizure frequency was a significant predictor of IQ change following surgery. Interactions between other, not included, possible predictors remain to be examined. Single-operated patients had the best cognitive outcome. The inclusion of a non-surgical control group is needed to assess the extent of the beneficial effects of surgery on cognitive ability.
