Long-term full-scale intelligent quotient outcomes following pediatric and childhood epilepsy surgery: A systematic review and meta-analysis

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

“…Our meta-analysis identified ASM cessation as predictive of intellectual and developmental gains. Although some studies found no association between ASM freedom and intellectual outcome, 18,37,51 including a recent metaanalysis, 52 others showed more pronounced intellectual improvements in ASM-free patients 17 and identified ASM cessation as the strongest predictor of postsurgical intellectual gains. 19 Our results are in line with the TimeToStop study, 20,53 which showed that the more ASMs are reduced, the higher the postsurgical intellectual functioning and the higher the IQ gain.…”

“…Seizure freedom alone was not predictive of intellectual and developmental gains in our meta-analysis, corroborating the previous IQ-based work. 52 Postsurgical intellectual improvement has been reported in seizurefree children, 17,[22][23][24]43,45 particularly compared to those with seizure recurrence. 25,38 Seizure freedom has been identified as the strongest predictor of intellectual gains at long-term follow-up in some studies, 18,23 contradicted by others.…”

“…This observation is in line with monocentric small to moderate-size pediatric cohorts suggesting an overall stable intellectual and developmental trajectory several years after surgery 13,17,22,37,45,48,56 as well as with a recent systematic review and meta-analysis of intellectual outcome ≥5 years after surgery. 52 This latter study analyzed both study-level data (n = 7 studies) and individual participant data (n = 2 studies) and reported a statistically although not clinically significant increase of 3.36 full-scale IQ points at follow-up. 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.…”

“…52 This latter study analyzed both study-level data (n = 7 studies) and individual participant data (n = 2 studies) and reported a statistically although not clinically significant increase of 3.36 full-scale IQ points at follow-up. 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.…”

“…Presurgical intellectual and developmental functioning was below average in most included studies, particularly in those reporting DQ, 26,32 in contrast to a recent systematic review and meta-analysis, which considered only studies reporting IQ. 52 Although eight studies reported some postsurgical improvement, only one reported a change from below to within the average range. 50 Lack of postsurgical gains in the short term may result from the loss of function with the resected brain tissue.…”