Abstract
BackgroundWe aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing—pre-2011 vs. established—post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical).MethodsWe analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient’s epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change.ResultsEpilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model.DiscussionPost-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients’ potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.
Highlights
Epilepsy surgery represents an established method for treatment of focal drug resistant epilepsy in both children and adults (Ryvlin, Cross & Rheims, 2014)
Paediatric patients (≤19 years of age) investigated for and having undergone epilepsy surgery in Motol Epilepsy Centre between January 1st, 2000 and December 31st, 2017 with available data on (i) results of pre- and post-surgical neuropsychological evaluation, (ii) seizure outcome one year after epilepsy surgery in patients included in analysis of postsurgical IQ/DQ and on (iii) pre- and post-surgical epilepsy- and epilepsy surgery-related variables were included in the study
By comparing two periods of epilepsy surgery program, we aimed to analyse whether changes in patient population and novel diagnostic and treatment strategies that we report elsewhere (Belohlavkova et al, 2019) were reflected in cognitive performance of patients included in the study
Summary
Epilepsy surgery represents an established method for treatment of focal drug resistant epilepsy in both children and adults (Ryvlin, Cross & Rheims, 2014). In an extensive review (Van Schooneveld & Braun, 2013), multiple pre-, post-surgical and surgery-related variables affecting cognitive performance before and after epilepsy surgery were identified, including epilepsy duration, underlying aetiology, age at surgery, seizure outcome, etc. Multiple additional factors play their role in cognitive development of children with focal structural epilepsy, such as the extent of the epileptogenic zone and of the zone of dysfunction, the epileptiform discharges and the effects of antiepileptic medication. Their interacting effects may influence patients’ long-term prognosis to achieve freedom from seizures and optimal cognitive development (Moosa & Wyllie, 2017). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ
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