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Updated: Jul 31, 2025
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Is There a Cognitive Decline in Pediatric Patients Following Epilepsy Surgery?
Konstantin L Makridis1, Sebastian Hoyer2, Christian E Elger3
1Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany; German Epilepsy Center for Children and Adolescents, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Cell- and Neurobiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Insights
Epilepsy surgery can cure drug-resistant epilepsy (DRE) and improve cognitive development in children. While IQ scores may slightly decrease, individual raw scores show cognitive progress, indicating successful surgical outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Neuroscience
- Epileptology
Background:
- Drug-resistant epilepsy (DRE) in children and adolescents often requires surgical intervention for potential cure.
- Epilepsy surgery may offer benefits beyond seizure control, including positive effects on cognitive development.
- The impact of epilepsy surgery on the cognitive trajectory of young patients remains an area of critical investigation.
Purpose of the Study:
- To analyze the cognitive development of children and adolescents with DRE before and after undergoing epilepsy surgery.
- To determine if epilepsy surgery leads to cognitive deterioration or improvement in pediatric patients.
- To evaluate the correlation between IQ changes and actual cognitive abilities post-surgery.
Main Methods:
- Retrospective evaluation of cognitive development in pediatric patients with DRE.
- Inclusion of 53 children and adolescents who underwent epilepsy surgery.
- Assessment of cognitive function using standardized tests and caretaker reports, comparing pre- and post-operative data.
Main Results:
- A high seizure freedom rate (86.8%) was achieved post-surgery.
- Presurgically, 76.7% of patients exhibited cognitive impairment, with a median IQ/development quotient of 74.
- Post-surgery, caretakers reported developmental progress in all patients, despite a slight median IQ decrease; individual raw scores indicated cognitive gains.
Conclusions:
- Epilepsy surgery does not result in cognitive deterioration in pediatric patients.
- A decrease in IQ points does not necessarily reflect a loss of cognitive abilities; individual raw score analysis is crucial.
- Pediatric patients undergoing epilepsy surgery show individual cognitive benefits, even if their development speed is slower than peers.
Background:
Epilepsy surgery is currently the only way to cure drug-resistant epilepsy (DRE). The loss of epileptic activity or its propagation in the developing brain may not only result in seizure freedom but also be associated with further positive effects. Here, we analyzed the cognitive development of children and adolescents with DRE after epilepsy surgery.
Methods:
We evaluated retrospectively the cognitive development of children and adolescents before and after epilepsy surgery.
Results:
Fifty-three children and adolescents underwent epilepsy surgery at a median age of 7.62 years. Overall seizure freedom was 86.8% at a current median observation period of 20 months. Presurgically, 81.1% had the clinical diagnosis of cognitive impairment, which was confirmed by standardized tests in 43 of 53 patients (76.7%). Further 10 patients had severe cognitive impairment rendering a standardized test impossible. The median intelligence quotient (IQ)/development quotient value was 74. After surgery, caretakers reported developmental progress in all patients, whereas the median IQ decreased slightly (P = 0.404). In eight patients the IQ points decreased after surgery; however, their individual raw scores increased in line with their reported increase in cognitive abilities.
Conclusions:
We did not detect any cognitive deterioration in children following epilepsy surgery. A loss of IQ points did not correspond to a real loss of cognitive abilities. These patients developed more slowly than age-matched peers with an average development speed but profited individually as seen in their raw scores. Therefore, an individual analysis of raw scores is relevant to assess the cognitive development after surgery.
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