Cognitive performance in distinct groups of children undergoing epilepsy surgery—a single-centre experience

PeerJ

article

Barbora Benova¹  Anezka Belohlavkova¹  Petr Jezdik³  Alena Jahodová¹  Martin Kudr¹  Vladimir Komarek¹  Vilem Novak¹  Petr Liby⁵  Robert Lesko¹  Michal Tichý¹  Martin Kyncl¹  Josef Zamecnik¹  Pavel Krsek¹  Alice Maulisova⁸ 

[1] 2nd Faculty of Medicine, Charles University Prague;Department of Paediatric Neurology, Motol University Hospital;Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University of Prague;Department of Paediatric Neurology, Ostrava Faculty Hospital;Department of Neurosurgery, Motol University Hospital;Department of Radiology, Motol Universiy Hospital;Department of Pathology and Molecular Medicine, Motol University Hospital;Department of Clinical Psychology, Motol University Hospital

关键词: Drug resistant epilepsy;    Paediatric epilepsy surgery;    Malformations of cortical development;    Cognitive outcome;    Long-term epilepsy-associated tumours;   

DOI  :  10.7717/peerj.7790

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundWe aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing—pre-2011 vs. established—post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical).MethodsWe analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient’s epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change.ResultsEpilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model.DiscussionPost-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients’ potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.

【 授权许可】

CC BY