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Published on: September 20, 2024
IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis
Tristan Schmidlechner1, Malin Zaddach1, Florian Heinen1
1Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
Insights
Epilepsy surgery in children with intractable epilepsy shows a modest average gain in intellectual function. Seizure freedom and stopping anti-seizure medications after surgery correlate with greater intellectual gains.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Psychology
Background:
- Medically intractable epilepsy in children significantly impacts cognitive development.
- Assessing the intellectual outcomes following epilepsy surgery is crucial for treatment planning and prognosis.
Approach:
- A systematic review and random-effects meta-analysis of 57 studies involving 2593 children.
- Included studies reported intelligence quotient (IQ) or developmental quotient (DQ) changes pre- and post-surgery for medically intractable epilepsy.
- PRISMA guidelines were followed, with data searched from PubMed and Web of Science.
Key Points:
- A pooled analysis revealed a significant mean gain of +2.52 Full Scale IQ (FSIQ) points.
- Higher FSIQ gains were observed in children who achieved seizure freedom (+5.58) and those who discontinued anti-seizure medications (+6.37).
- Controlled studies indicated better outcomes in the surgical group compared to non-surgical controls.
Conclusions:
- Epilepsy surgery in children with intractable epilepsy is associated with a mean gain in FSIQ and DQ.
- The observed FSIQ gain suggests stabilization of intellectual function, with greater improvements in seizure-free and medication-free patients.
- Further research is needed to understand individual changes and long-term effects of specific surgical interventions.
Objective:
This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy.
Methods:
A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ.
Results:
Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ.
Significance:
The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
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