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Neuropsychological effect of temporal lobe resection in preadolescent children with epilepsy
C A Szabó1, E Wyllie, L D Stanford
1Department of Neurology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Temporal lobectomy in children may impact verbal memory, with some experiencing declines, particularly those with higher baseline memory or left-sided resections. Further research is needed to understand long-term effects.
Area of Science:
- Pediatric Neurology
- Neuropsychology
- Epilepsy Surgery
Background:
- Temporal lobectomy is a common epilepsy surgery with known cognitive effects in adults and adolescents.
- Limited data exists on the neuropsychological outcomes of temporal lobectomy in preadolescent children.
Purpose of the Study:
- To evaluate the neuropsychological outcomes in preadolescent children following temporal lobectomy for intractable epilepsy.
- To identify potential predictors of cognitive changes after surgery in this age group.
Main Methods:
- Retrospective analysis of pre- and postoperative neuropsychological test results from 14 children (aged 7-12 years) undergoing temporal lobe resection.
- Assessment of cognitive functions including IQ, verbal, and memory performance.
- Seizure outcomes and follow-up duration were also recorded.
Main Results:
- Most patients (93%) achieved seizure freedom or significant reduction post-surgery.
- No significant changes were observed in overall Verbal, Performance, or Full Scale IQ.
- A significant decrease in immediate verbal memory was noted in children with higher preoperative scores and those undergoing left-sided resection.
- Delayed verbal memory scores showed a significant decline across the entire group.
Conclusions:
- Preadolescent children may be vulnerable to postoperative declines in immediate verbal memory, especially those with higher baseline function or left temporal lobe resection.
- Delayed verbal memory consistently decreased post-surgery.
- Larger studies are warranted to fully elucidate the risks and benefits of temporal lobe resection in childhood epilepsy.
Purpose:
Numerous studies have demonstrated changes in cognitive, memory, and language functioning in adults and adolescents after temporal lobectomy, yet little information is available regarding neuropsychological outcome in preadolescent children.
Methods:
We studied pre- and postoperative neuropsychological test results from 14 children who underwent temporal lobe resection for intractable epilepsy at age 7-12 years (mean 9.4 years).
Results:
Thirteen patients (93%) had no seizures or less than one seizure a year at follow-up 23-48 months (mean 34 months) after operation. Postoperative neuropsychological testing was performed 6-9 months (mean 7 months) after surgery in 13 patients and 36 months after the first operation in 1 patient who underwent two-stage resection of a tumor. Verbal, Performance, and Full Scale IQ were initially in the low-average range, with no significant change across the pre- and postoperative evaluations. Immediate verbal memory performance decreased significantly in children who initially performed above the median preoperatively and tended to decrease in children who had left rather than right temporal lobe resection. Significant postoperative decreases in delayed memory scores were independent of preoperative ability or side of resection.
Conclusions:
Our small study suggests vulnerability to postoperative decline in immediate verbal memory scores in preadolescent children who have higher baseline immediate memory function or undergo left rather than right temporal lobe resection, similar to that observed in adolescents in adults. The entire group exhibited a statistically significant decrease in delayed verbal memory. Study of larger series of patients will be important to clarify further the short- and long-term risks and benefits of temporal lobe resection in childhood.
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