Correlates of intellectual development before and after hemispherotomy: an analysis of 75 children and adolescents

Abstract

This study describes the intellectual development of 75 children and adolescents who underwent hemispherotomy. Furthermore, we aimed to reveal predicting factors on pre-and postsurgical development with a focus on the role of aetiology. Methods. We analysed presurgical and six-month postsurgical developmental and intellectual data of 75 patients (age range: 0.87-19.78 years) and divided them into two groups: a not severely impaired group in which outcome of intellectual functioning was reported based on FSIQ score, and a severely impaired group (not testable by IQ tests) in which intellectual developmental outcome was described based on developmental quotients instead. Results. In the not severely impaired group (n = 31), the preoperative level of intellectual functioning was a strong predictor of postoperative intellectual outcome; for 22/31 (71%) patients, postoperative FSIQ and its subscales were similar to preoperative levels. Improvements were observed for FSIQ in five patients, only for Verbal IQ in one patient and only for Performance IQ in one further patient; significant losses occurred in two patients, only for Performance IQ in both. In the severely impaired group, 30/40 (75%) patients showed further development after surgery, nine (23%) patients had the same results as before surgery, and one (2%) patient showed regression. Longer duration of presurgical epilepsy was related to a marginally lower presurgical developmental level, and good seizure outcome was a predictor Some of the results were presented on the Annual Meeting of the Gesellschaft für Epilep

Non-verbal Intelligence in Unilateral Perinatal Stroke Patients With and Without Epilepsies

“…The major finding of our study was that epilepsy is a key risk factor for impaired non-verbal cognitive abilities in children with perinatal stroke. This has already been known for severe pharmaco-refractory epilepsies ( 3 , 4 , 21 , 22 ); in the current study, we could demonstrate that negative effects can also be seen even in patients with well-controlled epilepsies, i.e., with seizure-freedom for at least 6 months. Despite our comprehensive assessment, none of the other potentially modifying factors lesion size, lesion side, language lateralization, or hand motor impairment played any role beyond the deleterious effects of epilepsy.…”

“…In addition to the burden of seizures and side effects of anti-epileptic medication, epilepsy may also hamper cognitive development. For children with pharmaco-refractory epilepsies due to perinatal strokes, it is well-known that cognitive development can be severely compromised ( 3 , 4 , 21 , 22 ). Much less is known, whether less severe, well-controlled epilepsies also play a role in this regard.…”

IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis

“…Post hoc analysis showed that no single study had noticeably strong influence on the pooled estimate or heterogeneity with the overall effect size ranging from 2.08 to 2.88 (Online Resource 3). Omitting studies in which the age at surgery ranged above 18 years ( n = 4) did not change the overall effect size drastically (mean difference = 2.6, 95% CI 1.12–4.07) [ 26 – 29 ]. Of the six studies that are not included in the forest plot, five showed improved FSIQ and one showed minimal decline resulting in a mean change of FSIQ of + 3.96 (± 2.35, range − 0.01 to 6.43).…”

“…Therefore, the pooled estimate does not represent all included studies. Of 44 studies reporting on FSIQ outcomes, six studies could not be incorporated in the comparison between pre- and postoperative FSIQ [ 22 , 29 , 50 – 53 ]. Since these six studies added up to a mean change of FSIQ of 3.96, it can be assumed that meta-analysis would have yielded a higher overall pooled estimate if the studies were included.…”

Cognitive development after perinatal unilateral infarctions: No evidence for preferential sparing of verbal functions

“…This somewhat contradicts older studies proposing a relative sparing of verbal over nonverbal functions, especially studies supporting the crowding hypothesis (Teuber 1974, Rasmussen and Milner 1977, Strauss, Satz et al 1990). This discrepancy may be explained by the fact that some of these studies used hand motor-dependent tests for measuring nonverbal functions, so that low scores in nonverbal cognition of hemiparetic children were possibly due to motor impairment rather than limitation of intelligence (Ballantyne, Spilkin et al 2008, Westmacott, Askalan et al 2010, van Buuren, van der Aa et al 2013, Bajer, Hofer et al 2020. Furthermore, many of these studies included patients with severely impaired cognitive functions and pharmaco-refractory epilepsies (Ballantyne, Spilkin et al 2008, van Buuren, van der Aa et al 2013, Bajer, Hofer et al 2020.…”