Identification of lateralized cognitive profiles in surgical and nonsurgical pediatric epilepsy patients using the...

A primary goal of neuropsychological evaluation is to identify cognitive strengths and weaknesses to guide interventions. The Cognitive Lateralization Index (CLRI) has been established as a way to quantify lateralization of dysfunction in pediatric epilepsy surgical cohorts, but not yet in nonsurgical cohorts. This study examined differences in cognitive lateralization between surgical and nonsurgical pediatric epilepsy patients.

Retrospective review was completed for surgical or nonsurgical epilepsy patients under age 18 with sufficient neuropsychological data for CLRI calculation. Hemispheric seizure lateralization was determined by scalp EEG for nonsurgical, and, if available, by stereotactic EEG in surgical patients. Seizure type was determined by seizure semiology. Primary analyses included frequency, descriptive, and X² tests.

A total of 82 patients were included (36 female, 46 male) with 35 surgical and 47 nonsurgical patients. Of patients with a known etiology, 65.9% were structural. Surgical patients had predominantly focal epilepsy (88.6%). Most patients had a mild degree of lateralization (45.1%). Most had a nondominant CLRI (59.8%) versus a nonlateralized CLRI (8.5%). Patients with right hemispheric and generalized/multifocal lateralized seizures more often had a nondominant CLRI. Surgical versus nonsurgical analyses revealed no significant difference between the degree of lateralization (X² (3,82) = 1.34, p = 0.72), nor between the 3 CLRI categories, (X² (2,82) = 3.20, p = 0.20).

This study establishes the generalizability of the CLRI to nonsurgical epilepsy patients and emphasizes the CLRI's ability to detect lateralized profiles in children with epilepsy. Despite significant differences in seizure lateralization, there were no significant differences in cognitive lateralization between surgical and nonsurgical patients.