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Pediatric frontal lobe epilepsy surgery: long-term neuropsychological outcomes and their predictors

Itay Tokatly Latzer1, Jefferey Bolton2, Scellig Stone3

  • 1Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Gray School of Medicine, Gray Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel.

Epilepsy & Behavior : E&B
|March 10, 2026
PubMed

Insights

Pediatric frontal lobe surgery outcomes are mostly stable or improved long-term. Key predictors of neuropsychological function include epilepsy etiology, resection extent, and specific brain network involvement.

Area of Science:

  • Neuroscience
  • Pediatric Neurology
  • Cognitive Psychology

Background:

  • Long-term neuropsychological outcomes following pediatric frontal lobe surgery are not well understood.
  • Understanding these outcomes is crucial for patient care and surgical planning.

Purpose of the Study:

  • To describe domain-specific neuropsychological outcomes after pediatric frontal lobe surgery.
  • To identify clinical predictors of these outcomes in a large pediatric cohort.

Main Methods:

  • Observational study comparing pre- and postoperative neuropsychological assessments in children undergoing frontal lobe epilepsy surgery.
  • Evaluated full-scale IQ (FSIQ), language, visuomotor skills, attention/working memory, executive functions, memory, behavior, and adaptive abilities.
  • Used effect-adjusted reliable change indices or >1.0 SD cutoff to define clinically significant change; examined demographic, epilepsy, and surgical factors as predictors.

Main Results:

  • 78 children evaluated median 2.5 years post-surgery; 72% stable, 13% improved, 15% declined.
  • Visuomotor skills had highest decline rate; executive functions showed highest improvement.
  • Younger age at onset predicted language/attention decline; tumor/vascular etiologies predicted stability/improvement; multiple lesions predicted declines.
  • Resections in ventromedial/orbitofrontal regions linked to FSIQ decline; extensive resections associated with attention/behavioral decline.

Conclusions:

  • Medium- to long-term neuropsychological outcomes after pediatric frontal lobe surgery are generally preserved or improved.
  • Etiology, extent of resection, and involvement of specific brain networks significantly impact outcomes.
  • Highlights the need for early evaluation, precise network mapping, and meticulous surgical technique.
Abstract

Keywords:
AdaptiveBehaviorCognitiveNeuropsychiatricSeizures

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