Cognitive assessment in epilepsy surgery of children

Battaglia, Domenica; Chieffo, Daniela Pia Rosaria; Lettori, Donatella; Perrino, Francesca; Rocco, Concezio Di; Guzzetta, Andrea

doi:10.1007/s00381-006-0151-2

Cited by 46 publications

(34 citation statements)

References 83 publications

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“…This reassuring finding is consistent with those of prior studies 24, 27, 55–58 . Despite the overall group-level stability, some individuals demonstrated significant changes in FSIQ.…”

Section: Discussionsupporting

confidence: 92%

Fifty Consecutive Hemispherectomies

Lew¹,

Koop

Mueller³

et al. 2014

Neurosurgery

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Background Techniques for achieving hemispheric disconnection in patients with epilepsy continue to evolve. Objective To review the outcomes of the first 50 hemispherectomy surgeries performed by a single surgeon with an emphasis on outcomes, complications, and how these results led to changes in practice. Methods The first 50 hemispherectomy cases performed by the lead author were identified from a prospectively maintained database. Patient demographics, surgical details, clinical outcomes, and complications were critically reviewed. Results From 2004 to 2012, 50 patients underwent hemispherectomy surgery (mean follow-up time 3.5 years). Modified lateral hemispherotomy (MLH) became the preferred technique and was performed on 44 patients. Forty patients (80%) achieved complete seizure freedom (Engel I). Pre- and post-surgical neuropsychological evaluations demonstrated cognitive stability. Two cases were performed for palliation only. Previous hemispherectomy surgery was associated with worsened seizure outcome (2 of 6 seizure-free, P = .005). The use of Avitene was associated with a higher incidence of postoperative hydrocephalus (56% v. 18%, P = .03). In MLH patients without the use of Avitene, the incidence of hydrocephalus was 13%. Complications included: infection (3), incomplete disconnection requiring reoperation (1), reversible ischemic neurologic deficit (1), and craniosynostosis (1). There were no (unanticipated) permanent neurological deficits or deaths. Minor technique modifications were made in response to specific complications. Conclusion The modified lateral hemispherotomy is effective and safe for both initial and revision hemispherectomy surgery. Avitene use appears to result in a greater incidence of postoperative hydrocephalus.

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“…This reassuring finding is consistent with those of prior studies 24, 27, 55–58 . Despite the overall group-level stability, some individuals demonstrated significant changes in FSIQ.…”

Section: Discussionsupporting

confidence: 92%

Fifty Consecutive Hemispherectomies

Lew¹,

Koop

Mueller³

et al. 2014

Neurosurgery

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show abstract

“…Moreover, the etiology and location of epilepsy, as well as the surgical procedures, differ considerably between children and adults [16]. The neuropsychological assessment before and after surgery allows for the identification of developmental delay, stagnation or deterioration and for the identification of predictive factors of cognitive development [17]. Few studies have reported the long-term neuropsychological outcome after epilepsy surgery in children [4,18,19].…”

Section: Discussionmentioning

confidence: 99%

Cognitive development from two to ten years after pediatric epilepsy surgery

Viggedal

Kristjánsdóttir

Olssøn

et al. 2012

Epilepsy & Behavior

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“…In spite of the recognized role of presurgical neuropsychological evaluation of children with pharmacoresistant epilepsy [4,22], there are many methodological limits to perform it in patients with posterior quadrant dysplasia, i.e., the young age of the patients which unfavourably combines with the discontinuity of infantile scales and psychometric tests. The examination of neurosensory functions, in particular visual and auditory functions, according to the most recent attitude [2,13], might help in this context to evaluate some early aspects of neurodevelopment in these patients.…”

Section: Neuropsychological Evaluationmentioning

confidence: 99%

“…More perplexities exist regarding the use of extraoperative subdural EEG monitoring. The main reasons that have been cited in favor of avoiding it in posterior quadrantic epilepsy patients are the following: [1] the likelihood of a multilobar epileptogenic zone, rendering it difficult to perform an adequate covering of it with grids and electrodes; [2] the anticipation that subdural EEG monitoring would similarly show widespread, nonlocalized EEG abnormalities or fail to localize seizures due to spatial sampling issues; [3] the minimal risk from TPO surgery to determine language or motor deficits, given the nature of the lesions and the degree of preexisting developmental delays; [4] the greater likelihood of seizure freedom with a multilobar procedure than with a localized resection, prompted by a subdural EEG finding; and [5] the added risks, costs, and delays associated with a protocol including extraoperative subdural EEG recordings [20]. A more uniform consent relates to the use of intraoperative cortical mapping.…”

Section: The Role Of Intraoperative Electrocorticography and Intraopementioning

confidence: 99%

Surgery for posterior quadrantic cortical dysplasia. A review

et al. 2014

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Seizures appear most commonly in infants and rapidly progress to a catastrophic course. They are mostly represented by focal seizures and spasms. Surface interictal video-EEG is characterized by background flattening and paroxysmal discharges prevalent on the affected side but not unusually extending to the controlateral hemisphere. The last occasionally shows an independent irritative activity in spite of the absence of further visible structural abnormalities. Most of the patients have visual field or visual attention deficits at diagnosis. Resective as well as disconnective surgical procedures have been proposed for the management of this condition, none of them having shown clear advantages in terms of seizure outcome and complications. Intraoperative electrocorticography (EcoG) and sensorimotor monitoring have been successfully used to improve the localization of the epileptic focus and reduce surgical complication rates. Undistincted lesion borders, independent controlateral ictal or/and interictal EEG activity, and incomplete resections/disconnections are among the main factors that have resulted to be associated with a worse seizure outcome.

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Cognitive assessment in epilepsy surgery of children

Abstract: We underline the importance of multicentric studies with standardized neuropsychological assessments in large series of young children.

Cited by 46 publications

References 83 publications

Fifty Consecutive Hemispherectomies

Fifty Consecutive Hemispherectomies

Cognitive development from two to ten years after pediatric epilepsy surgery

Surgery for posterior quadrantic cortical dysplasia. A review

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