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Schmidlechner T, Zaddach M, Heinen F, Cornell S, Ramantani G, Rémi J, Vollmar C, Kunz M, Borggraefe I. IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis. J Neurol 2024; 271:177-187. [PMID: 37770569 PMCID: PMC10770207 DOI: 10.1007/s00415-023-12002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. METHODS A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. RESULTS Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. SIGNIFICANCE The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
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Affiliation(s)
- Tristan Schmidlechner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Malin Zaddach
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
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Chericoni A, Ricci L, Ntolkeras G, Billardello R, Stone SSD, Madsen JR, Papadelis C, Grant PE, Pearl PL, Taffoni F, Rotenberg A, Tamilia E. Sleep Spindle Generation Before and After Epilepsy Surgery: A Source Imaging Study in Children with Drug-Resistant Epilepsy. Brain Topogr 2024; 37:88-101. [PMID: 37737957 DOI: 10.1007/s10548-023-01007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Literature lacks studies investigating the cortical generation of sleep spindles in drug-resistant epilepsy (DRE) and how they evolve after resection of the epileptogenic zone (EZ). Here, we examined sleep EEGs of children with focal DRE who became seizure-free after focal epilepsy surgery, and aimed to investigate the changes in the spindle generation before and after the surgery using low-density scalp EEG and electrical source imaging (ESI). METHODS We analyzed N2-sleep EEGs from 19 children with DRE before and after surgery. We identified slow (8-12 Hz) and fast spindles (13-16 Hz), computed their spectral features and cortical generators through ESI and computed their distance from the EZ and irritative zone (IZ). We performed two-way ANOVA testing the effect of spindle type (slow vs. fast) and surgical phase (pre-surgery vs. post-surgery) on each feature. RESULTS Power, frequency and cortical activation of slow spindles increased after surgery (p < 0.005), while this was not seen for fast spindles. Before surgery, the cortical generators of slow spindles were closer to the EZ (57.3 vs. 66.2 mm, p = 0.007) and IZ (41.3 vs. 55.5 mm, p = 0.02) than fast spindle generators. CONCLUSIONS Our data indicate alterations in the EEG slow spindles after resective epilepsy surgery. Fast spindle generation on the contrary did not change after surgery. Although the study is limited by its retrospective nature, lack of healthy controls, and reduced cortical spatial sampling, our findings suggest a spatial relationship between the slow spindles and the epileptogenic generators.
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Affiliation(s)
- Assia Chericoni
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Lorenzo Ricci
- Department of Medicine and Surgery, Research Unit of Neurology, Neurobiology, Neurophysiology, University Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Georgios Ntolkeras
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Billardello
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Advanced Robotics and Human-Centred Technologies - CREO Lab, Campus Bio-Medico di Roma, Rome, Italy
| | - Scellig S D Stone
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Joseph R Madsen
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook children's Health Care System, Boston, TX, USA
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - P Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fabrizio Taffoni
- Advanced Robotics and Human-Centred Technologies - CREO Lab, Campus Bio-Medico di Roma, Rome, Italy
| | - Alexander Rotenberg
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleonora Tamilia
- Fetal Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Laguitton V, Boutin M, Brissart H, Breuillard D, Bilger M, Forthoffer N, Guinet V, Hennion S, Kleitz C, Mirabel H, Mosca C, Pradier S, Samson S, Voltzenlogel V, Planton M, Denos M, Bulteau C. Neuropsychological assessment in pediatric epilepsy surgery: A French procedure consensus. Rev Neurol (Paris) 2023:S0035-3787(23)01106-2. [PMID: 37949750 DOI: 10.1016/j.neurol.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 11/12/2023]
Abstract
Neuropsychological assessment is a mandatory part of the pre- and post-operative evaluation in pediatric epilepsy surgery. The neuropsychology task force of the ILAE - French Chapter aims to define a neuropsychological procedure consensus based on literature review and adapted for French practice. They performed a systematic review of the literature published between 1950 and 2023 on cognitive evaluation of individuals undergoing presurgical work-up and post-surgery follow-up and focused on the pediatric population aged 6-16. They classified publications listed in the PubMed database according to their level of scientific evidence. The systematic literature review revealed no study with high statistical power and only four studies using neuropsychological scales in their French version. Afterwards, the experts defined a neuropsychological consensus strategy in pediatric epilepsy surgery according to the psychometric determinants of cognitive tests, specificity of epilepsy, surgery context, French culture and literature reports. A common French neuropsychological procedure dedicated to pediatric epilepsy surgery is now available. This procedure could serve as a guide for the pre- and post-surgical work-up in French centers with pediatric epilepsy surgery programs. The main goal is to anticipate the functional risks of surgery, to support the postoperative outcome beyond the seizure-related one, while taking into consideration the plasticity and vulnerability of the immature brain and allowing the possibility of collaborative studies.
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Affiliation(s)
- V Laguitton
- Clinical Neurophysiology AP-HM, Timone Hospital, Marseille, France; Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France.
| | - M Boutin
- GHU-Paris Pôle Neuro-Sainte-Anne - Neurosurgery Unity, 1, rue Cabanis, Paris, France
| | - H Brissart
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Service de Neurologie, 54000 Nancy, France
| | - D Breuillard
- Reference Center Rare Epilepsies, Hôpital Necker Enfants-Malades, Paris, France
| | - M Bilger
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - N Forthoffer
- Université de Lorraine, CNRS, CRAN, 54000 Nancy, France
| | - V Guinet
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - S Hennion
- Reference Center Rare Epilepsies, Epilepsy Unit, University Lille, INSERM, CHU Lille, U1171 Degenerative and vascular cognitive disorders, Lille, France
| | - C Kleitz
- Neurology Department, Hôpital Hautepierre, CHRU Strasbourg, Strasbourg, France
| | - H Mirabel
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France
| | - C Mosca
- Epilepsy Unit, CHU Grenoble-Alpes, Grenoble-Alpes, France
| | - S Pradier
- Functional Explorations of the Nervous System, Clinical Neurosciences Center, University Hospital Center Pellegrin, Bordeaux, France
| | - S Samson
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France; Équipe Neuropsychologie: Audition, Cognition et Action (EA 4072), UFR de psychologie, Université Lille-Nord de France, Villeneuve d'Ascq, France
| | - V Voltzenlogel
- Centre d'études et de recherches en psychopathologie et psychologie de la santé, université de Toulouse, UT2J, Toulouse, France
| | - M Planton
- Neurology Department, Hôpital Pierre-Paul Riquet, CHU de Toulouse, Toulouse, France; Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - M Denos
- Neurology Department, Rehabilitation Unit, GH Pitié-Salpêtrière, APHP, Paris, France
| | - C Bulteau
- Pediatric Neurosurgery Department, Rothschild Foundation Hospital, EpiCare Member, Paris, France; University of Paris Cité, MC(2)Lab, Institute of Psychology, 92000 Boulogne-Billancourt, France
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Sherlock C, Madigan C, Linehan C, Keenan L, Downes M. Academic attainment following pediatric epilepsy surgery: A systematic review. Epilepsy Behav 2022; 134:108847. [PMID: 35914437 DOI: 10.1016/j.yebeh.2022.108847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/03/2022]
Abstract
Academic skills, such as reading, spelling and arithmetic, are central to meaningful engagement with society throughout adolescence and into adulthood. The disruption caused by on-going seizure activity places children with drug-resistant epilepsy at a particularly high risk of poor academic attainment. Though epilepsy surgery during childhood has long-been associated with various cognitive changes, less is known of the extent to which pediatric epilepsy surgery impacts academic attainment. The aim of the present systematic review was to identify the nature of the effect of pediatric epilepsy surgery on the core academic skills of reading, writing, and arithmetic. The electronic databases Embase, Medline, PubMed, PsychInfo, OpenAire, and the ISRCTN registry were searched for studies examining academic attainment following epilepsy surgery in childhood, over the last three decades. Two thousand three-hundred and sixty-eight articles were screened for relevance. Thirteen studies met the inclusion criteria. Study quality and reliability were independently assessed by two reviewers. Results indicate that academic attainment primarily stabilizes in the first year following epilepsy surgery. Though changes to learning ability would not be expected in this early recovery phase, this review indicates that children do not, at least, lose the academic skills they have acquired before surgery. Postoperative declines in performance were most notably recorded in assessments of arithmetic, suggesting an area of potential vulnerability in this cohort. These declines were noted in cohorts with the longest periods between seizure onset and surgery. While older age at onset and seizure freedom correlated with improved academic attainment, further research is necessary to fully understand the specific effect of epilepsy surgery on academic attainment. Still, the present review provides valuable information regarding the likely academic outcomes in the early years following surgical treatment for drug-resistant epilepsy.
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Affiliation(s)
- Clara Sherlock
- University College Dublin, UCD School of Psychology, Dublin, Ireland.
| | - Cathy Madigan
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Christine Linehan
- University College Dublin, UCD School of Psychology, Dublin, Ireland; UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - Lisa Keenan
- University College Dublin, UCD School of Psychology, Dublin, Ireland
| | - Michelle Downes
- University College Dublin, UCD School of Psychology, Dublin, Ireland
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Lineweaver TT, Collins AN, Stopa MM, Horth MS, Fishbaugh ME, Haut J, Ferguson L, Klaas P, Lachhwani D, Bingaman W, Busch RM. Mother knows best… or does she? Perceptions of the memory abilities of pediatric patients with epilepsy as reported by patients and their parents across time. Epilepsy Behav 2022; 128:108589. [PMID: 35182849 DOI: 10.1016/j.yebeh.2022.108589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study compared the self-reported and parent-reported memory of children with epilepsy across time and explored the relationships between these measures of subjective memory and the children's actual performance on objective neuropsychological tests. METHOD One-hundred and nineteen children with epilepsy who were surgical candidates underwent comprehensive neuropsychological testing that included the Everyday Verbal Memory Questionnaire (EVMQ). Each child's parent and 82 of the children themselves completed the appropriate version of this subjective memory measure. After 9 months, the children returned for a second neuropsychological evaluation with 71 parents and 39 children completing the same questionnaire. Approximately one-third of the children in the study underwent surgery between the two evaluations. Standardized regression-based norms were used to quantify change in cognitive abilities across assessments. RESULTS Results revealed significant relationships between parent reports and child reports of the children's memory abilities. Parent reports, but not child reports, correlated with the children's objective test scores at baseline. In contrast, children were more attuned to changes in their memory across time. CONCLUSIONS These findings demonstrate the importance of considering both parent and child perceptions of everyday cognitive functioning when evaluating cognition and cognitive changes over time in pediatric patients with epilepsy.
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Affiliation(s)
- Tara T Lineweaver
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States.
| | - Abbey N Collins
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Margaret M Stopa
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Madison S Horth
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Megan E Fishbaugh
- Department of Psychology, Butler University, 4600 Sunset Avenue, Indianapolis, IN 46208, United States
| | - Jennifer Haut
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Lisa Ferguson
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Patricia Klaas
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Deepak Lachhwani
- Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - William Bingaman
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robyn M Busch
- Department of Psychiatry & Psychology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Department of Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States; Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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Laguitton V, Desnous B, Lépine A, McGonigal A, Mancini J, Daquin G, Girard N, Scavarda D, Trébuchon A, Milh M, Bartolomei F, Villeneuve N. Intellectual outcome from 1 to 5 years after epilepsy surgery in 81 children and adolescents: A longitudinal study. Seizure 2021; 91:384-392. [PMID: 34298457 DOI: 10.1016/j.seizure.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This longitudinal study aimed to measure the time course of intellectual changes after pediatric focal resective epilepsy surgery and to identify their predictors. METHODS We analyzed a cohort of 81 school-aged children with focal epilepsy and intractable seizures who underwent neurosurgery (focal resection) from 2000 to 2018 in La Timone Hospital (Marseille). Neuropsychological assessments were carried out before and then 1, 2, 3, and 5 years after epilepsy surgery. RESULTS Eighty-one patients with a median age at surgery of 13.74 years [4.25] were enrolled. Overall, 45 of the 81 (55%) recruited patients were improved after the surgery on at least one of the five domains of the Wechsler Intelligence Scale. Temporal lobe localization and postoperative seizure freedom were the main prognostic factors impacting intellectual outcome (improvement and decline) after epilepsy surgery. Younger patients at surgery were less likely to have a postoperative IQ decline. Intellectual improvement after epilepsy surgery could be delayed for up to 5 years after surgery and concerned all intellectual domains except the Verbal Comprehension Index (VCI). Intellectual decline after epilepsy surgery occurred mainly during the first two years after the surgery and was reflected in full-scale intelligence quotient (FSIQ) and Working Memory Index (WMI). CONCLUSIONS Our study points out that children and adolescents with TLE who achieved freedom from seizure after epilepsy surgery are the leading candidates for achieving postoperative intellectual improvement. This enhancement in intellectual function shows a long time course, whereas intellectual decline is evidenced earlier.
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Affiliation(s)
- Virginie Laguitton
- Clinical Neurophysiology APHM, Timone Hospital, Marseille, France; Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France
| | - Béatrice Desnous
- Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France.
| | - Anne Lépine
- Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France
| | - Aileen McGonigal
- Clinical Neurophysiology APHM, Timone Hospital, Marseille, France; Aix Marseille University, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Julien Mancini
- Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, Timone Hospital, BioSTIC, Marseille, France
| | - Géraldine Daquin
- Clinical Neurophysiology APHM, Timone Hospital, Marseille, France
| | - Nadine Girard
- Department of Neuroradiology, APHM, Timone Hospital, Marseille, France; Aix-Marseille University, UMR 7339, CNRS, Marseille, France
| | - Didier Scavarda
- Department of Pediatric Neurosurgery, APHM, Timone Hospital, Marseille, France
| | - Agnès Trébuchon
- Clinical Neurophysiology APHM, Timone Hospital, Marseille, France; Aix Marseille University, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Mathieu Milh
- Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France; INSERM UMR-S 910, Marseille 13385, France
| | - Fabrice Bartolomei
- Clinical Neurophysiology APHM, Timone Hospital, Marseille, France; Aix Marseille University, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Nathalie Villeneuve
- Department of Pediatric Neurology, APHM, Timone Hospital, Marseille, France; Centre Ressource Autisme, APHM, Sainte Marguerite Hospital, 13009 Marseille, France
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Honda R, Baba H, Adachi K, Koshimoto R, Ono T, Toda K, Tanaka S, Baba S, Yamasaki K, Yatsuhashi H. Developmental outcome after corpus callosotomy for infants and young children with drug-resistant epilepsy. Epilepsy Behav 2021; 117:107799. [PMID: 33610103 DOI: 10.1016/j.yebeh.2021.107799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/26/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022]
Abstract
AIM To examine the developmental and seizure outcomes after corpus callosotomy (CC) in early childhood. METHODS We retrospectively identified 106 patients who underwent CC for drug-resistant epilepsy before the age of 6 years, at the Nagasaki Medical Center, between July 2002 and July 2016. Patients' developmental outcomes were evaluated one year after CC using the Kinder Infant Development Scale. RESULTS The mean preoperative developmental quotient (DQ) was 25.0 (standard deviation [SD], 20.8), and the mean difference between preoperative DQ and one-year postoperative DQ was -1.6 points (SD, 11.6). However, 42.5% of patients had a mean DQ increase of 6.5 points (SD, 6.4), one year after CC from that before surgery. Factors related to the improvement in postoperative DQ were 'low preoperative DQ', 'developmental gain 1 month postoperatively', and 'postoperative seizure-free state'. Approximately 21.7% of patients were seizure-free 1 year after CC. INTERPRETATION Performing CC, in infancy and early childhood for patients with drug-resistant epilepsy and severe developmental impairment, was associated with improved development in 42.5% of patients. Remission of seizures, even if only for a short period, contributed to developmental improvement. From a developmental perspective, CC for drug-resistant epilepsy in early childhood is an effective treatment.
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Affiliation(s)
- Ryoko Honda
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan; Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Hiroshi Baba
- Department of Neurosurgery, Nishiisahaya Hospital, Nagasaki, Japan; Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Kohei Adachi
- Department of Comprehensive Community Care Services, Nagasaki Junshin Catholic University, Japan
| | - Rika Koshimoto
- Psychological Counselling Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Tomonori Ono
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Keisuke Toda
- Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan; Department of Neurosurgery, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Shigeki Tanaka
- Department of Pediatrics, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Shiro Baba
- Department of Neurosurgery, Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazumi Yamasaki
- Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
| | - Hiroshi Yatsuhashi
- Nagasaki University School of Medicine Graduate School of Biomedical Sciences, Nagasaki, Japan; Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan
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8
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Barba C, Cossu M, Guerrini R, Di Gennaro G, Villani F, De Palma L, Grisotto L, Consales A, Battaglia D, Zamponi N, d'Orio P, Revay M, Rizzi M, Casciato S, Esposito V, Quarato PP, Di Giacomo R, Didato G, Pastori C, Pavia GC, Pellacani S, Matta G, Pacetti M, Tamburrini G, Cesaroni E, Colicchio G, Vatti G, Asioli S, Caulo M, Marras CE, Tassi L. Temporal lobe epilepsy surgery in children and adults: A multicenter study. Epilepsia 2020; 62:128-142. [PMID: 33258120 DOI: 10.1111/epi.16772] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/11/2020] [Accepted: 11/04/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess seizure and cognitive outcomes and their predictors in children (<16 years at surgery) and adults undergoing temporal lobe epilepsy (TLE) surgery in eight Italian centers. METHODS This is a retrospective multicenter study. We performed a descriptive analysis and subsequently carried out multivariable mixed-effect models corrected for multiple comparisons. RESULTS We analyzed data from 511 patients (114 children) and observed significant differences in several clinical features between adults and children. The possibility of achieving Engel class IA outcome and discontinuing antiepileptic drugs (AEDs) at last follow-up (FU) was significantly higher in children (P = .006 and < .0001). However, percentages of children and adults in Engel class I at last FU (mean ± SD, 45.9 ± 17 months in children; 45.9 ± 20.6 months in adults) did not differ significantly. We identified different predictors of seizure outcome in children vs adults and at short- vs long-term FU. The only variables consistently associated with class I outcome over time were postoperative electroencephalography (EEG) in adults (abnormal, improved,odds ratio [OR] = 0.414, P = .023, Q = 0.046 vs normal, at 2-year FU and abnormal, improved, OR = 0.301, P = .001, Q = 0.002 vs normal, at last FU) and the completeness of resection of temporal magnetic resonance (MR) abnormalities other than hippocampal sclerosis in children (OR = 7.93, P = .001, Q = 0.003, at 2-year FU and OR = 45.03, P < .0001, Q < 0.0001, at last FU). Cognitive outcome was best predicted by preoperative performances in either age group. SIGNIFICANCE Clinical differences between adult and pediatric patients undergoing TLE surgery are reflected in differences in long-term outcomes and predictors of failures. Children are more likely to achieve sustained seizure freedom and withdraw AEDs after TLE surgery. Earlier referral should be encouraged as it can improve surgical outcome.
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Affiliation(s)
- Carmen Barba
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy
| | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Renzo Guerrini
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy.,IRCCS Stella Maris, Pisa, Italy
| | | | - Flavio Villani
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy.,Division of Neurophysiology and Epilepsy Centre, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca De Palma
- Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Grisotto
- Department of Statistics, Computer Science, Application "G. Parenti", University of Florence, Florence, Italy
| | - Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Domenica Battaglia
- Child Psychiatry and Neurology Unit, Policlinic Agostino Gemelli Foundation, IRCCS, Roma, Italy
| | - Nelia Zamponi
- Child Psychiatry and Neurology Unit, G. Sales Hospital, Ancona, Italy
| | - Piergiorgio d'Orio
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy.,Institute of Neuroscience, CNR, Parma, Italy
| | - Martina Revay
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Michele Rizzi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, Italy.,Department of Human Neurosciences, Sapienza University, Rome, Italy
| | | | - Roberta Di Giacomo
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Giuseppe Didato
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Chiara Pastori
- Member of the ERN EpiCARE, Epilepsy Unit, IRCCS "C. Besta" Neurological Institute Foundation, Milan, Italy
| | - Giusy Carfi Pavia
- Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Simona Pellacani
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy
| | - Giulia Matta
- Member of the ERN EpiCARE, Neuroscience Department, Meyer Children's Hospital -University of Florence, Florence, Italy
| | - Mattia Pacetti
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Policlinic Agostino Gemelli Foundation, IRCCS, Rome, Italy
| | | | | | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Carlo Efisio Marras
- Member of the ERN EpiCARE, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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9
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Jakobsen AV, Müller E, Uldall PV. A methodological perspective on the cognitive outcome of epilepsy surgery in children and adolescents. Epilepsy Behav 2020; 111:107330. [PMID: 32759075 DOI: 10.1016/j.yebeh.2020.107330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of the study was to explore the impact of timing and test specificity of cognitive outcome measures after pediatric epilepsy surgery. METHODS A consecutive national cohort of 114 children with medically resistant epilepsy having had resective epilepsy surgery were screened for children tested with a complete age-appropriate Wechsler Intelligence test at two or three time-points. This provided 43 children for analyses. Composite subscale scores were assessed in comparison to index and intelligence quotient (IQ) scores. RESULTS We found a main effect of time in seizure-free children for full-scale IQ (FSIQ); F(2, 42) = 6.49 with higher T2 measures compared with T1 (MDiff = 5.46, p = .006). There was a difference in FSIQ scores between seizure-free and nonseizure-free children at T2; M = 7.31, 95% confidence interval (CI) [0.05 to 14.57], t(38) = 2.04, p = .049, favoring seizure-free children. A statistical difference between composite scale scores and index scores was found with medium to large effect. The correlation of medical treatment (anti-epileptic drug (AED)) change and score differences in FSIQ outcome was significant (p = .041), with less AED correlated with a higher FSIQ. All children with left-temporal surgery had a stable or improved verbal comprehension composite subscale score outcome at T2 regardless of seizure status. CONCLUSION Our results correspond to some longitudinal studies with outcome measures >2 years, in contrast to short-term studies ≤2 years with a stable outcome. Our study supports the fact that the specificity of the used tests and the timing of assessments after pediatric epilepsy surgery are essential factors for the clinical validity of outcome measures. However, there are further needs of extensive longitudinal studies to provide a better understanding of life-long cognitive development and impact after childhood epilepsy surgery.
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Affiliation(s)
- Anne Vagner Jakobsen
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark.
| | - Elisabeth Müller
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilhelm Uldall
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark; Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
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10
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de Knegt VE, Hoei-Hansen CE, Knudsen M, Jakobsen AV, Mûller E, Thomsen KM, Jespersen B, Uldall PV, Børresen ML. Increase in cognitive function is seen in many single-operated pediatric patients after epilepsy surgery. Seizure 2020; 81:254-262. [PMID: 32911236 DOI: 10.1016/j.seizure.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The recurrent seizures of pediatric drug-resistant epilepsy (DRE) are known to impair brain development and can lead to a loss in cognitive functioning. Surgery is increasingly being used to treat children with DRE. This study investigates the pre- and postoperative cognitive function in a pediatric epilepsy surgery cohort as well as predictive determinants of change in intelligence quotient (IQ) following surgery. METHODS A consecutive series of 91 Danish children who underwent focal resective epilepsy surgery between January 1996 and December 2016 were included. All underwent preoperative cognitive evaluation and were reevaluated at 1-year and/or 2-year follow-up. Single-operated and multi-operated patients were examined separately. RESULTS 79 of 91 patients were single-operated. Single-operated patients received less anti-epileptic drugs (AED) and experienced a decrease in seizure frequency postoperatively, p < 0.001. IQ increased postoperatively (IQ change ± standard deviation: 3.3 ± 14.0), p < 0.05. High preoperative seizure frequency was a significant predictor for decreased IQ, p < 0.01. Multi-operated patients did not experience a reduction in AED treatment. Surgery and continued AED treatment did, however, result in significantly better seizure control, p < 0.01. IQ remained unchanged in multi-operated patients. CONCLUSION Epilepsy surgery allowed for IQ gains in single-operated patients. Preoperative seizure frequency was a significant predictor of IQ change following surgery. Interactions between other, not included, possible predictors remain to be examined. Single-operated patients had the best cognitive outcome. The inclusion of a non-surgical control group is needed to assess the extent of the beneficial effects of surgery on cognitive ability.
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Affiliation(s)
| | | | - Marianne Knudsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anne Vagner Jakobsen
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Elisabeth Mûller
- Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Katrine Moe Thomsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bo Jespersen
- Department of Neurosurgery, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter Vilhelm Uldall
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Neuropediatrics, The Danish Epilepsy Center, Filadelfia, Dianalund, Denmark
| | - Malene Landbo Børresen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
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11
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Bach Q, Thomale UW, Müller S. Parents' and children's decision-making and experiences in pediatric epilepsy surgery. Epilepsy Behav 2020; 107:107078. [PMID: 32320930 DOI: 10.1016/j.yebeh.2020.107078] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In pediatric epilepsy surgery, little research has been conducted on parents' decision-making for or against surgery, their satisfaction with the surgical outcome, as well as their children's personal experiences with the process. OBJECTIVE This study explores (1) factors that may influence parents' decision-making, (2) factors associated with their postoperative satisfaction, and (3) their children's involvement in decision-making and their experiences with epilepsy surgery. METHODS Self-developed questionnaires were provided to parents and their children in Germany, Switzerland, and Austria. Clinical and psychosocial differences between parents who decided for or against surgery, as well as associations between postoperative factors and the parents' satisfaction were statistically analyzed. RESULTS Fifty-one questionnaires (42 parent and nine patient questionnaires) were evaluated. Parents who decided for epilepsy surgery reported significantly more frequently to have received a good medical consultation and a consistent recommendation. They made significantly less use of information websites, internet forums, and patient organizations. Their children were classified as more intelligent and resisted surgery less. Most of the parents were satisfied with the surgical outcome (83%). Parents were significantly more satisfied when their children had fewer medication side effects, their memory or concentration had improved, their character or behavior had changed in a positive direction, or when their children were more independent or less excluded. They were also significantly more content when they had more free time to themselves and their professional situation or their relationship with their children, friends, or other family members had improved. However, no significant association was found between parental satisfaction and reduced number of medications or improved seizure outcome. Although the children were reported to have been minimally involved in the decision-making process, they were satisfied with their involvement. CONCLUSIONS A good medical consultation that involves the children and considers the family's living conditions is a crucial factor for parents' decision-making on pediatric epilepsy surgery. For parents' satisfaction, a positive change in their child's character or behavior and an improved psychosocial situation of the family are more important than postoperative seizure frequency or number of antiepileptic drugs (AEDs). Therefore, the medical consultation should not only focus on clinical factors, but also point out psychosocial and behavioral changes that may occur after the surgical treatment.
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Affiliation(s)
- Quynh Bach
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, CCM, Research Division of Mind and Brain, Charitéplatz 1, 10117 Berlin, Germany.
| | - Ulrich-Wilhelm Thomale
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Pediatric Neurosurgery, CVK, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Sabine Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, CCM, Research Division of Mind and Brain, Charitéplatz 1, 10117 Berlin, Germany.
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12
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Jain P, Smith ML, Speechley K, Ferro M, Connolly M, Ramachandrannair R, Almubarak S, Andrade A, Widjaja E. Seizure freedom improves health-related quality of life after epilepsy surgery in children. Dev Med Child Neurol 2020; 62:600-608. [PMID: 31709524 DOI: 10.1111/dmcn.14390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
Abstract
AIM To determine whether epilepsy surgery improved health-related quality of life (HRQoL) and whether seizure freedom after surgery mediated the improvement in HRQoL. METHOD This multicenter cohort study compared HRQoL after epilepsy surgery to pharmacological management in children with drug-resistant epilepsy (DRE). HRQoL was measured using the Quality of Life in Childhood Epilepsy (QOLCE) questionnaire at baseline and 1-year follow-up. The mediator between treatment type and HRQoL was seizure freedom. RESULTS Two hundred and thirty-seven patients were recruited (surgery group: n=147 [92 males, 45 females]; pharmacological group: n=90 [53 males, 37 females]). Mean age at seizure onset was 6 years (SD 4y 4mo) in the surgical group and 6 years 1 month (SD 4y) in the pharmacological group. The odds ratio of seizure freedom was higher for the surgery versus pharmacological group (β=4.24 [95% confidence interval {CI}: 2.26-7.93], p<0.001). Surgery had no direct effect on total QOLCE score at 1-year (β=0.24 [95% CI -2.04 to 2.51], p=0.839) compared to pharmacological management, but had an indirect effect on total QOLCE that was mediated by seizure freedom (β=0.92 [95% CI 0.19-1.65], p=0.013), adjusting for baseline total QOLCE score. Surgery had a direct effect on improving social function (p=0.043), and an indirect effect on improving physical function (p=0.016), cognition (p=0.042), social function (p=0.012) and behavior (p=0.032), mediated by seizure freedom. INTERPRETATION Greater seizure freedom achieved through epilepsy surgery mediated the improvement in HRQoL compared to pharmacological management in children with DRE. WHAT THIS PAPER ADDS Seizure freedom is higher after pediatric epilepsy surgery compared to pharmacologically managed epilepsy. Surgery indirectly improves health-related quality of life (HRQoL) mediated by seizure freedom compared to pharmacological management. Surgery has a direct effect on improving social function relative to pharmacological management. Baseline HRQoL was an important predictor of HRQoL after treatment.
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Affiliation(s)
- Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Pediatric Neurology, Department of Pediatrics, BLK Super Speciality Hospital, New Delhi, India.,Division of Pediatric Neurology, Department of Pediatrics, Danat Al Emarat Hospital for Women and Children, Abu Dhabi, UAE
| | - Mary Lou Smith
- Department of Psychology, University of Toronto Mississauga, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathy Speechley
- Department of Paediatrics, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Mark Ferro
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary Connolly
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Salah Almubarak
- Division of Pediatric Neurology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Andrea Andrade
- Department of Pediatrics, London Health Sciences Center, University of Western Ontario, London, Ontario, Canada
| | - Elysa Widjaja
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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13
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Barba C, Cross JH, Braun K, Cossu M, Klotz KA, De Masi S, Perez Jiménez MA, Gaily E, Specchio N, Cabral P, Toulouse J, Dimova P, Battaglia D, Freri E, Consales A, Cesaroni E, Tarta-Arsene O, Gil-Nagel A, Mindruta I, Di Gennaro G, Giulioni M, Tisdall MM, Eltze C, Tahir MZ, Jansen F, van Rijen P, Sanders M, Tassi L, Francione S, Lo Russo G, Jacobs J, Bast T, Matta G, Budke M, Fournier Del Castillo C, Metsahonkala EL, Karppinen A, Ferreira JC, Minkin K, Marras CE, Arzimanoglou A, Guerrini R. Trends in pediatric epilepsy surgery in Europe between 2008 and 2015: Country-, center-, and age-specific variation. Epilepsia 2019; 61:216-227. [PMID: 31876960 DOI: 10.1111/epi.16414] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. METHODS We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. RESULTS We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P < .0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend = .0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend = .0047) and a significant decrease in unilobar temporal surgeries (P for trend = .0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo-electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. SIGNIFICANCE Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures.
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Affiliation(s)
- Carmen Barba
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Judith Helen Cross
- University College London, National Institute for Health Research, Biomedical Research Centre, Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Kees Braun
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Massimo Cossu
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Kerstin Alexandra Klotz
- Department of Epileptology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Maria Angeles Perez Jiménez
- Epilepsy Surgery Program, Clinical Neurophysiology Section, Niño Jesús Pediatric University Hospital, Madrid, Spain
| | - Eija Gaily
- Epilepsia-Helsinki, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Nicola Specchio
- Rare and Complex Epilepsies Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pedro Cabral
- Department of Neurology, Pediatric Neurology Unit, Centro de Referência de Epilepsia Refractária, CRER, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Joseph Toulouse
- Department of Pediatric Clinical Epileptology, Sleep Disorders, and Functional Neurology, University Hospitals of Lyon, Lyon, France
| | - Petia Dimova
- Epilepsy Surgery Center, Department of Neurosurgery, St Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Domenica Battaglia
- Pediatric Neurology and Psychiatry Unit, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Elisabetta Cesaroni
- Child Neurology and Psychiatry Unit, G. Salesi Children's Hospital-University of Ancona, Ancona, Italy
| | - Oana Tarta-Arsene
- Pediatric Neurology Clinic, Al Obregia Hospital, Carol Davila University of Medicine, Bucharest, Romania
| | - Antonio Gil-Nagel
- Department of Neurology, Ruber International Hospital, Madrid, Spain
| | - Ioana Mindruta
- Epilepsy Monitoring Unit, Neurology Department, University Emergency Hospital of Bucharest, Bucharest, Romania
| | | | - Marco Giulioni
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | | | | | - Floor Jansen
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Peter van Rijen
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Maurits Sanders
- Department of Child Neurology, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Laura Tassi
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Stefano Francione
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giorgio Lo Russo
- Claudio Munari Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Julia Jacobs
- Department of Neuropediatrics and Muscle Disorders, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Bast
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Epilepsy Center Kork, Kehl-Kork, Germany
| | - Giulia Matta
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy
| | - Marcelo Budke
- Epilepsy Surgery Program, Neurosurgery Service, Niño Jesús Pediatric University Hospital, Madrid, Spain
| | | | - Eeva-Liisa Metsahonkala
- Epilepsia-Helsinki, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Atte Karppinen
- Epilepsia-Helsinki and Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - José Carlos Ferreira
- Department of Neurology, Pediatric Neurology Unit, Centro de Referência de Epilepsia Refractária, CRER, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Krasimir Minkin
- Epilepsy Surgery Center, Department of Neurosurgery, St Ivan Rilski University Hospital, Sofia, Bulgaria
| | | | | | - Alexis Arzimanoglou
- Department of Pediatric Clinical Epileptology, Sleep Disorders, and Functional Neurology, University Hospitals of Lyon, Lyon, France
| | - Renzo Guerrini
- Neuroscience Department, Children's Hospital Meyer-University of Florence, Florence, Italy.,IRCCS Stella Maris, Pisa, Italy
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14
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Hoppe C, Porębska I, Beeres K, Sassen R, Kuczaty S, Gleissner U, Lendt M, Elger CE, Helmstaedter C. Parents' view of the cognitive outcome one year after pediatric epilepsy surgery. Epilepsy Behav 2019; 101:106552. [PMID: 31698257 DOI: 10.1016/j.yebeh.2019.106552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The cognitive outcome of pediatric epilepsy surgery has mainly been examined on the basis of standardized tests. Here, we analyzed the outcome in six cognitive domains from the parents' view. METHODS Included were consecutive surgical pediatric patients whose parents filled-in a comprehensive questionnaire on cognitive problems in children and adolescents (Kognitive Probleme bei Kindern und Jugendlichen (KOPKIJ); Gleissner et al. 2006) at the preoperative baseline (T1) as well as twelve months thereafter (T2). All children also underwent standard neuropsychological assessments at T1 and T2. RESULTS Parents of 96 patients provided pre- and postoperative KOPKIJ data. Overall, 80% of the children became seizure-free at the follow-up. Group means indicated a strong positive effect of time on KOPKIJ and neuropsychological performance. We found postoperative improvements in five out of six cognitive domains (language, memory, executive functions, attention, school; unchanged: visuospatial abilities). Individually, improvements were twice as likely as declines. However, 33 patients (35%) experienced significant decline in at least one cognitive domain. Later onset of epilepsy resulted in better performance but had no effect on change scores. Seizure-free status, lower antiseizure drug load, and stronger drug reduction after surgery contributed to postoperative cognitive improvements as perceived by the parents; no other effects of clinical factors were obtained (e.g., localization/lateralization). Despite their similar outcome patterns, change scores as derived from parental ratings and neuropsychological assessment were not correlated. CONCLUSIONS Parents acknowledged the overall positive neurocognitive development after pediatric epilepsy surgery as previously shown by standardized tests. Seizure freedom and lower antiseizure drug load contributed to the beneficial cognitive outcome. Even if cognitive improvements outweighed declines, a risk for cognitive decline with impact on everyday functioning does exist.
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Affiliation(s)
- Christian Hoppe
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany.
| | - Izabela Porębska
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Kassandra Beeres
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Robert Sassen
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Stefan Kuczaty
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Ulrike Gleissner
- LVR-Klinik Bonn, Kinderneurologisches Zentrum, Waldenburger Ring 46, FRG-53119 Bonn, Germany
| | - Michael Lendt
- St. Mauritius Therapieklinik, Strümper Str. 111, FRG-40670 Meerbusch, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany
| | - Christoph Helmstaedter
- Department of Epileptology, University of Bonn Medical Centre, Venusberg-Campus 1, FRG-53127 Bonn, Germany; St. Mauritius Therapieklinik, Strümper Str. 111, FRG-40670 Meerbusch, Germany
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15
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Phillips NL, Widjaja E, Smith ML. Impact of resective surgery for pediatric drug-resistant epilepsy on emotional functioning. Epilepsy Behav 2019; 101:106508. [PMID: 31677581 DOI: 10.1016/j.yebeh.2019.106508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate emotional functioning following surgical and medical treatment in children with drug-resistant epilepsy (DRE; i.e., uncontrolled seizures despite treatment with ≥2 antiepileptic drugs [AED]). METHOD This prospective, longitudinal, multicenter study involved 128 children and adolescents (8-18 years) with DRE who were assessed for surgical candidacy; 48 went on to have surgery and 80 continued medical treatment. Participants completed child-validated self-report measures of anxiety and depression at baseline, 6, and 12 month follow-up. Standardized z-scores were calculated with higher scores indicative of greater symptoms. RESULTS At baseline, 16% and 22% of all patients reported elevated symptoms of depression and anxiety, respectively (i.e., z ≥ 1.00). Seizure freedom was higher in the surgical, compared with the medical, group at 6 (64 vs. 11%) and 12 month (77 vs. 24%) follow-up. Linear mixed effects models controlling for age found a main effect of time for both depression and anxiety; scores decreased over time for all patients. A main effect of seizure outcome was found for depression, but not anxiety; seizure freedom was associated with lower scores overall. There were no main effects of treatment or significant interactions. Multiple regression analyses found baseline mood predicted outcomes at 6 and 12 month follow-up; higher anxiety and depression scores at baseline were associated with higher scores at follow-up. Older age and greater number of AEDs at baseline was associated with higher depression scores at 12 month follow-up. CONCLUSION Overall, patients reported a reduction in anxiety and depressive symptoms over the first 12 months, irrespective of treatment, and baseline level of functioning was the best predictor of outcome. Despite more children achieving seizure freedom with surgery compared with medical treatment, surgery was not associated with better outcomes over time. It may be that changes in anxiety and depression require a longer time to emerge postsurgery; however, being seizure-free is associated with fewer depressive symptoms, irrespective of treatment type.
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Affiliation(s)
- Natalie L Phillips
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Elysa Widjaja
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Mary Lou Smith
- Neurosciences and Mental Health Program, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada; Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Psychology, University of Toronto Mississauga, 3359 Mississauga Road, Toronto, Ontario L5L 1C6, Canada.
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16
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Novak V, Maulisova A, Jezdik P, Benova B, Belohlavkova A, Liby P, Tichy M, Krsek P. Generalized quasiperiodic epileptiform activity in sleep is associated with cognitive impairment in children with drug-resistant focal lesional epilepsy. Epilepsia 2019; 60:2263-2276. [PMID: 31612465 DOI: 10.1111/epi.16362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the impact of generalized quasiperiodic epileptiform discharges ("hurdles") observed in non-rapid eye movement (NREM) sleep on cognitive function in children with intractable focal epilepsy. "Hurdles" pattern does not meet the criteria of the electrical status epilepticus in slow-wave sleep (ESES). METHODS In a retrospective analysis, 24 patients with "hurdles" and their 24 peers matched for demographic and epilepsy-related variables were compared in terms of neuropsychological domains and electroencephalography (EEG)-derived quantifiers. Both "hurdles" and controls were children between 2 and 19 years of age who had intractable focal epilepsy evaluated as candidates of resective epilepsy surgery. RESULTS Full-scale intelligence quotient/developmental quotient (FSIQ/DQ) (P = .002) and visuoconstructional skills (P = .004) were significantly lower in children with "hurdles" compared to controls. Patients with "hurdles" presented with higher interictal spike indexes in sleep (P < .001, median difference -0.9, 95% confidence interval [CI] -1.4, -0.6) and wakefulness (P < .001, median difference -0.3, 95% CI -0.5, -1). Relative time of sleep spindles in NREM sleep was significantly reduced (P < .001, median difference 0.1, 95% CI 0.0, 0.1) in the "hurdles" group. The time proportion of sleep spindles represented a significant positive (P = .008) and spike index of generalized spikes in sleep a significant negative explanatory variable (P = .004) of FSIQ/DQ scores. The proportion of seizure-free patients 2 years after epilepsy surgery did not differ significantly between the two groups (P = .19). SIGNIFICANCE Although the "hurdles" pattern does not fulfill the criteria of ESES, it is associated with a pronounced cognitive dysfunction. Disturbed sleep structure marked by reduced sleep spindles and generalized spiking in sleep is associated with worse cognitive performance. Despite having a generalized nature, we did not find a lower probability of postsurgical seizure freedom in patients with "hurdles" pattern.
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Affiliation(s)
- Vilem Novak
- Department of Paediatric Neurology, Ostrava Faculty Hospital, Ostrava, Czech Republic.,Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Alice Maulisova
- Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic
| | - Petr Jezdik
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University of Prague, Prague, Czech Republic
| | - Barbora Benova
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Anezka Belohlavkova
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Petr Liby
- Department of Neurosurgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague 5, Czech Republic
| | - Michal Tichy
- Department of Neurosurgery, 2nd Faculty of Medicine, Motol University Hospital, Charles University, Prague 5, Czech Republic
| | - Pavel Krsek
- Second Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
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17
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Benova B, Belohlavkova A, Jezdik P, Jahodová A, Kudr M, Komarek V, Novak V, Liby P, Lesko R, Tichý M, Kyncl M, Zamecnik J, Krsek P, Maulisova A. Cognitive performance in distinct groups of children undergoing epilepsy surgery-a single-centre experience. PeerJ 2019; 7:e7790. [PMID: 31608172 PMCID: PMC6788437 DOI: 10.7717/peerj.7790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/29/2019] [Indexed: 11/27/2022] Open
Abstract
Background We 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). Methods We 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. Results Epilepsy 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. Discussion Post-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.
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Affiliation(s)
- Barbora Benova
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Anezka Belohlavkova
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Petr Jezdik
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University of Prague, Prague, Czech Republic
| | - Alena Jahodová
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Martin Kudr
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Vladimir Komarek
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Vilem Novak
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Ostrava Faculty Hospital, Ostrava, Czech Republic
| | - Petr Liby
- Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Robert Lesko
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Michal Tichý
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Radiology, Motol Universiy Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Pathology and Molecular Medicine, Motol University Hospital, Prague, Czech Republic
| | - Pavel Krsek
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Alice Maulisova
- Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic
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18
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Veersema TJ, van Schooneveld MMJ, Ferrier CH, van Eijsden P, Gosselaar PH, van Rijen PC, Spliet WGM, Mühlebner A, Aronica E, Braun KPJ. Cognitive functioning after epilepsy surgery in children with mild malformation of cortical development and focal cortical dysplasia. Epilepsy Behav 2019; 94:209-215. [PMID: 30974349 DOI: 10.1016/j.yebeh.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
Mild malformation of cortical development (mMCD) and focal cortical dysplasia (FCD) subtypes combined are by far the most common histological diagnoses in children who undergo surgery as treatment for refractory epilepsy. In patients with refractory epilepsy, a substantial burden of disease is due to cognitive impairment. We studied intelligence quotient (IQ) or developmental quotient (DQ) values and their change after epilepsy surgery in a consecutive series of 42 children (median age at surgery: 4.5, range: 0-17.0 years) with refractory epilepsy due to mMCD/FCD. Cognitive impairment, defined as IQ/DQ below 70, was present in 51% prior to surgery. Cognitive impairment was associated with earlier onset of epilepsy, longer epilepsy duration, and FCD type I histology. Clinically relevant improvement of ≥10 IQ/DQ points was found in 24% of children and was related to the presence of presurgical epileptic encephalopathy (EE). At time of postsurgical cognitive testing, 59% of children were completely seizure-free (Engel 1A). We found no association between cognitive outcome and seizure or medication status at two years of follow-up. Epilepsy surgery in children with mMCD or FCD not only is likely to result in complete and continuous seizure freedom, but also improves cognitive function in many.
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Affiliation(s)
- Tim J Veersema
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter C van Rijen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Angelika Mühlebner
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
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19
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Reilly C, Baldeweg T, Stewart N, Wadhwani S, Jones C, Helen Cross J, Heyman I. Do behavior and emotions improve after pediatric epilepsy surgery? A systematic review. Epilepsia 2019; 60:885-897. [DOI: 10.1111/epi.14737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Colin Reilly
- Research Department Young Epilepsy Lingfield UK
- University College London Great Ormond Street Institute of Child Health London UK
| | - Torsten Baldeweg
- University College London Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
| | - Neil Stewart
- University College London Great Ormond Street Institute of Child Health London UK
| | - Suresh Wadhwani
- University College London Great Ormond Street Institute of Child Health London UK
| | - Chloe Jones
- Research Department Young Epilepsy Lingfield UK
- University College London Great Ormond Street Institute of Child Health London UK
| | - J. Helen Cross
- Research Department Young Epilepsy Lingfield UK
- University College London Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
| | - Isobel Heyman
- University College London Great Ormond Street Institute of Child Health London UK
- Great Ormond Street Hospital for Children National Health Service Trust London UK
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20
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Skirrow C, Cross JH, Owens R, Weiss‐Croft L, Martin‐Sanfilippo P, Banks T, Shah E, Harkness W, Vargha‐Khadem F, Baldeweg T. Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case‐control neuroimaging study. Epilepsia 2019; 60:872-884. [DOI: 10.1111/epi.14707] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Caroline Skirrow
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeuropsychologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
- Cambridge Cognition Cambridge UK
| | - J. Helen Cross
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeurologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Rosie Owens
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeuropsychologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Louise Weiss‐Croft
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeuropsychologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
- Science Gallery LondonKing's College London London UK
| | - Patricia Martin‐Sanfilippo
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeuropsychologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Tina Banks
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of RadiologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Emily Shah
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
| | - William Harkness
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeurosurgeryGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Faraneh Vargha‐Khadem
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeuropsychologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
| | - Torsten Baldeweg
- Developmental Neurosciences ProgrammeGreat Ormond Street Institute of Child Health, University College London London UK
- Department of NeuropsychologyGreat Ormond Street Hospital for Children NHS Foundation Trust London UK
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21
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Meng Y, Voisin MR, Suppiah S, Merali Z, Moghaddamjou A, Alotaibi NM, Manicat-Emo A, Weiss S, Go C, McCoy B, Donner EJ, Rutka JT. Risk factors for surgical site infection after intracranial electroencephalography monitoring for epilepsy in the pediatric population. J Neurosurg Pediatr 2018; 22:31-36. [PMID: 29624147 DOI: 10.3171/2018.1.peds17476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial electroencephalography (iEEG) monitoring is an important method of identifying the seizure focus in patients with medically refractory epilepsy. While previous studies have demonstrated low rates of surgical complications, reported rates of surgical site infection (SSI) are highly variable. To date, no studies have specifically evaluated the patient or operative risk factors contributing to SSI. The goals of this study were to examine the rate of SSI after iEEG monitoring for epilepsy workup in pediatric patients and to determine the variables that might contribute to the development of SSI. METHODS A retrospective analysis of hospital charts at the Hospital for Sick Children was performed for all patients who had undergone iEEG monitoring between 2000 and 2016. Univariate and multivariate analyses were performed to look for statistically significant variables in relation to SSI. RESULTS Among 199 patients eligible for analysis, 8 (4.0%) developed SSIs within a period ranging from 21 to 51 days postoperatively. Univariate analysis yielded 4 factors related to SSI: number of people present in the operating room on electrode insertion (p = 0.02), length of insertion surgery (p = 0.04), previous operation at the same surgical site (p = 0.04), and number of depth electrodes inserted (p = 0.01). Multivariate analysis revealed that both the number of people present during the implant operation (OR 0.08, 95% CI 0.01-0.70) and the number of depth electrodes inserted (OR 3.52, 95% CI 1.44-8.59) independently contributed to SSI. CONCLUSIONS This is the largest case series and the first comprehensive review of both patient and operative risk factors in the development of SSI from iEEG monitoring in a pediatric population. The authors' institution had a lower rate of infection than those in most other studies, which could be explained by their protocol of administering intravenous antibiotics perioperatively and post-implant removal antibiotics for 14 days. The authors found a correlation between SSI and the number of people present during the implant operation, as well as the number of depth electrodes; both may contribute to breaks in sterility.
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Affiliation(s)
- Ying Meng
- 1Division of Neurosurgery, University of Toronto; and
| | | | | | - Zamir Merali
- 1Division of Neurosurgery, University of Toronto; and
| | | | | | | | | | | | | | | | - James T Rutka
- 1Division of Neurosurgery, University of Toronto; and.,3Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Abstract
Cognitive dysfunction in children with epilepsy is primarily contributed by etiology, seizures, frequency of interictal epileptiform discharges, and adverse effects of antiepileptic drugs. The direct effect of epilepsy surgery on cognitive outcome depends on two key factors: the function that is present in the epileptogenic zone to be removed, and the dysfunction outside the epileptogenic zone caused by epilepsy. Studies on cognitive outcome in children after various types of epilepsy surgery estimate "no significant change" in about 70% of children, improvement in cognition in 10%-15%, and decline in 10%-15%. In young children with epileptic encephalopathy, the reversible dysfunction outside the epileptogenic zone is larger and hence carry better chances of improved outcome after successful surgery. If the epileptogenic zone harbors significant cognitive function (memory, language, or other function), then a decline in function may occur with its resection. Understanding the pathophysiological basis for the cognitive changes after epilepsy surgery assists in counseling patients and families before surgery.
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Affiliation(s)
- Ahsan N V Moosa
- Department of Neurology, Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH,.
| | - Elaine Wyllie
- Department of Neurology, Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH
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