Cognitive and developmental outcomes after pediatric insular epilepsy surgery for focal cortical dysplasia

Abstract

OBJECTIVECognitive risk associated with insular cortex resection is not well understood. The authors reviewed cognitive and developmental outcomes in pediatric patients who underwent resection of the epileptogenic zone involving the insula.METHODSA review was conducted of 15 patients who underwent resective epilepsy surgery involving the insular cortex for focal cortical dysplasia, with a minimum follow-up of 12 months. The median age at surgery was 5.6 years (range 0.3–13.6 years). Developmental/intelligence quotient (DQ/IQ) scores were evaluated before surgery, within 4 months after surgery, and at 12 months or more after surgery. Repeated measures multivariate ANOVA was used to evaluate the effects on outcomes of the within-subject factor (time) and between-subject factors (resection side, anterior insular resection, seizure control, and antiepileptic drug [AED] reduction).RESULTSThe mean preoperative DQ/IQ score was 60.7 ± 22.8. Left-side resection and anterior insular resection were performed in 9 patients each. Favorable seizure control (International League Against Epilepsy class 1–3) was achieved in 8 patients. Postoperative motor deficits were observed in 9 patients (permanent in 6, transient in 3). Within-subject changes in DQ/IQ were not significantly affected by insular resection (p = 0.13). Postoperative changes in DQ/IQ were not significantly affected by surgical side, anterior insular resection, AED reduction, or seizure outcome. Only verbal function showed no significant changes before and after surgery and no significant effects of within-subject factors.CONCLUSIONSResection involving the insula in children with impaired development or intelligence can be performed without significant reduction in DQ/IQ, but carries the risk of postoperative motor deficits.

Predictors of outcomes after surgery for medically intractable insular epilepsy: A systematic review and individual participant data meta‐analysis

“…[37][38][39] While major technological advances have made microsurgical resection for IE safer, permanent neurological impairment (eg, hemiplegia) rates exceed 20% in some contemporary series. 32,40 Characterizing the rate of transient and permanent deficits and their predictors may address concerns for the safety of surgery for IE and facilitate patient counseling. The identification of patient or operative variables associated with postoperative neurological deficits has the potential to refine surgical indications or modify the surgical technique, respectively.…”

Quantifying and reporting outcome measures in pediatric epilepsy surgery: A systematic review

“…Table 3 describes the studies that reported neuropsychological outcomes ( n = 32, 40%). A total of 36 different named neuropsychological outcome metrics were used, the Wechsler Intelligence Scale for Children (WISC) and its various versions being the most common ( n = 15, 47%) 23–32 . Eight (25%) of these studies did not specify how their neuropsychological outcomes were measured but generically stated a postoperative neuropsychological assessment was performed 33–40 …”

“…A total of 36 different named neuropsychological outcome metrics were used, the Wechsler Intelligence Scale for Children (WISC) and its various versions being the most common (n = 15, 47%). [23][24][25][26][27][28][29][30][31][32] Eight (25%) of these studies did not specify how their neuropsychological outcomes were measured but generically stated a postoperative neuropsychological assessment was performed. [33][34][35][36][37][38][39][40] Of the 36 named metrics, 6 (17%) have been validated and 3 (8%) had reliability studies performed (see Table 2) for pediatric patients with epilepsy.…”

Is Hippocampal Resection Necessary for Low-Grade Epilepsy-Associated Tumors in the Temporal Lobe?

“…The VI was represented by the verbal comprehension score in the WAIS or WISC or by the standardized value of the averaged sub-scores on language comprehension and language expression in KIDS [ 14 ]. The WMI was represented by the working memory score in the WAIS and WISC.…”