Daily executive functioning in adults with pediatric hemispherectomy

For young children with intractable epilepsy caused by congenital abnormalities or acquired cortical lesions, pediatric hemispherectomy surgery (pHS) may offer the only path to seizure remediation. Although some sensory and motor outcomes of pHS are highly predictable, the long-term cognitive and functional sequelae of pHS are far more variable. With the aim of identifying potential post-pHS intervention targets, the current study examined daily executive functioning and self-awareness in adults with pHS and broadly intact cognitive outcomes (indicated by average or above performance on intelligence tests).

This study used self- and informant-ratings on the Behavior Rating Inventory of Executive Functioning, Adult Version (BRIEF-A) everyday executive functioning in to evaluate adaptive behavior in 16 adults with pHS and Full-Scale IQ (FSIQ) of 77 or greater. Self- and informant-report results were compared to the normative sample, as was the proportion of participants with self vs. informant discrepancy scores of > 1 standard deviation.

Both participants and informants reported each participants' behaviors and executive functioning were largely commensurate with average range from test norms. On average, participants with pHS rated themselves as stronger than their peers at Self-Monitoring, possibly suggesting compensatory attention to issues surrounding their sensory-motor disabilities (e.g., hemiplegia and hemianopsia). Informant- and self-reports were generally consistent, with the exception of an elevated number of participants whose self-ratings indicated less impairment than informant-ratings on the Initiate subscale.

This study demonstrates that following pHS, adults with average (or higher) general cognition also exhibit daily executive functioning broadly commensurate with their peers, with the possible exceptions of elevated self-monitoring and greater likelihood of overestimating their initiation (compared to informant ratings).