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

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.

Long‐term intellectual and developmental outcomes after pediatric epilepsy surgery: A systematic review and meta‐analysis

“…Although the generalizability of these results is limited to children who can perform the age-appropriate IQ evaluation, 52 our study extends the observation of, on average, stable intellectual and developmental outcomes across the pediatric age group, including the crucial subgroup of very young children undergoing epilepsy surgery. 32,57,58 Finally, our study corroborates the findings of a recent systematic review and meta-analysis 59 in a larger sample comprising 57 studies/2593 patients, which investigated postsurgical IQ/DQ changes at any time point following pediatric epilepsy surgery and similarly found a (nonsignificant) mean gain of 1 IQ/DQ point, reflecting overall sustainability of intellectual and developmental functioning after surgery. These findings are particularly reassuring, because they support that resecting or disconnecting parts of the brain to avert epileptic seizures does not result in loss of capabilities but stabilizes intellectual development in most affected children.…”