Cognitive changes following surgery in intractable hemispheric and sub-hemispheric pediatric epilepsy
The objectives were to study the short and longitudinal changes in the cognitive skills of children with intractable epilepsy after hemispheric/sub-hemispheric epilepsy surgery.
Sixteen patients underwent surgery from September 2005 until March 2009. They underwent detailed presurgical evaluation of their cognitive skills and were repeated annually for 3 years.
Their mean age was 6.6 years. Epilepsy was due to Rasmussen’s encephalitis (n = 9), Infantile hemiplegia seizure syndrome (n = 2), hemimegalencephaly (n = 2), and Sturge Weber syndrome (n = 3). Fourteen (87.5%) patients underwent peri-insular hemispherotomy and two (12.5%) underwent peri-insular posterior quadrantectomy. The mental and social age, gross motor, fine motor, adaptive, and personal social skills showed a steady increase after surgery (p < 0.05). Language showed positive gains irrespective of the side and etiology of the lesion (p = 0.003). However, intelligence quotient (IQ) remained static on follow-up. Patients with acquired pathology gained more in their mental age, language, and conceptual thinking. Age of seizure onset and duration of seizures prior to surgery were predictive variables of postoperative cognitive skills.
There are short- and long-term gains in the cognitive skills of children with intractable epilepsy after hemispherotomy and posterior quadrantectomy that was better in those patients with acquired diseases. Age of seizure onset and duration of seizures prior to surgery were independent variables that predicted the postoperative outcome.
KeywordsIntractable epilepsy Epilepsy surgery Cognitive decline Cognitive outcome Children
We would like to acknowledge Prof. Jean Guy Villemure who mentored the surgical epilepsy program in Christian Medical College, Vellore, India. He was a constant source of support and encouragement throughout the establishment of this program. We also thank him for reviewing the manuscript of this research project.
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