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Published on: October 4, 2018
Determinants of intellectual and developmental outcomes in a multicenter pediatric hemispherotomy cohort
Georgia Ramantani1, Dorottya Cserpan1, Martin Tisdall2
1Department of Neuropediatrics, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland.
Insights
Hemispherotomy outcomes in children show that later epilepsy onset improves cognitive function. Discontinuing antiseizure medication (ASM) post-surgery is the only modifiable factor to optimize intellectual and developmental trajectories.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Developmental Neuroscience
Background:
- Hemispherotomy is a surgical procedure for intractable epilepsy.
- Understanding factors influencing post-surgical outcomes is crucial for patient management.
Purpose of the Study:
- To identify determinants of intellectual and developmental outcomes after pediatric hemispherotomy.
- To analyze a large, contemporary multicenter cohort.
Main Methods:
- Retrospective analysis of 296 children and adolescents undergoing hemispherotomy (2000-2016).
- Standardized post-surgical evaluation of intelligence or developmental quotient (IQ/DQ).
- Ordinal regression modeling used to identify outcome determinants.
Main Results:
- 60% discontinued antiseizure medication (ASM); 84% were seizure-free.
- 11% had normal, 16% mild, 22% moderate, and 51% severe intellectual/developmental impairment.
- Polymicrogyria, contralateral MRI abnormalities, and continued ASM were associated with poorer outcomes; later epilepsy onset with better outcomes.
Conclusions:
- Key determinants of outcomes include age at epilepsy onset, etiology, bilateral brain abnormalities, and postsurgical ASM management.
- Timely ASM discontinuation is a modifiable factor to optimize cognitive trajectories.
- Findings offer insights into factors influencing cognitive outcomes post-hemispherotomy.
Objective:
This study aimed to identify the determinants of intellectual and developmental outcomes following pediatric hemispherotomy in a large, contemporary multicenter cohort.
Methods:
We retrospectively analyzed the intellectual and developmental outcomes of 296 children and adolescents who underwent hemispherotomy between 2000 and 2016 and received a standardized postsurgical evaluation of intelligence or developmental quotient (IQ/DQ). Outcomes at the last follow-up were classified into four categories: normal (IQ/DQ > 85), mildly impaired (IQ/DQ = 70-84), moderately impaired (IQ/DQ = 55-69), or severely impaired (IQ/DQ < 55). Determinants of these outcomes were identified using ordinal regression modeling with imputation for missing data.
Results:
At a median follow-up of 2.1 years (interquartile range = 1.3-5.3), 84% of the children and adolescents were seizure-free, and 60% had discontinued antiseizure medication (ASM). Intellectual and developmental functioning at the last assessment was normal in 11% of the patients, mildly impaired in 16%, moderately impaired in 22%, and severely impaired in 51%. Higher functioning was less likely in patients with polymicrogyria as the underlying etiology (odds ratio [OR] = .3 [.11-.77], p = .013), those with contralateral magnetic resonance imaging abnormalities (OR = .47 [.22-.99], p = .047), and those who continued ASM after surgery (OR = .51 [.29-.9], p = .021). Conversely, patients with a later age at epilepsy onset were more likely to achieve higher functioning (OR = 1.16 [1.04-1.3], p = .011).
Significance:
Age at epilepsy onset, underlying etiology, presence of bilateral structural brain abnormalities, and postsurgical ASM management were key determinants of intellectual and developmental outcomes following hemispherotomy. These findings underscore the importance of timely ASM discontinuation as the only modifiable factor that may optimize intellectual and developmental trajectories. Although direct presurgical comparisons were not possible, the observed associations provide valuable insights into factors influencing cognitive outcomes.
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