Low IQ predicts worse long-term seizure outcome after resective epilepsy surgery – A propensity score matched analysis

Reinholdson, Jesper; Olssøn, Ingrid; Tranberg, Anna Edelvik; Malmgren, Kristina

doi:10.1016/j.eplepsyres.2023.107110

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…The presence of cognitive impairment has been found to be an important predictor of seizure outcome. 72 , 73 We have also previously used educational status, which is in itself reflective of neuropsychological functioning, as a feature in a predictive model of seizure outcome 74 ; however, there might be added value in including more fine-grained neuropsychological information in the form of test scores to a predictive model of seizure outcome.…”

Section: Discussionmentioning

confidence: 99%

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Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline?

Eriksson,

Prentice,

Piper

et al. 2024

Brain

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Neuropsychological impairments are common in children with drug-resistant epilepsy. It has been proposed that epilepsy surgery may alleviate these impairments by providing seizure freedom; however, findings from prior studies have been inconsistent. We mapped long-term neuropsychological trajectories in children before and after undergoing epilepsy surgery, to measure the impact of disease course and surgery on functioning. We performed a retrospective cohort study of 882 children who had undergone epilepsy surgery at Great Ormond Street Hospital (1990-2018). We extracted patient information and neuropsychological functioning – obtained from IQ tests (domains: Full-Scale IQ, Verbal IQ, Performance IQ, Working Memory, and Processing Speed) and tests of academic attainment (Reading, Spelling and Numeracy) – and investigated changes in functioning using regression analyses. We identified 500 children (248 females) who had undergone epilepsy surgery (median age at surgery = 11.9 years, interquartile range = [7.8,15.0]) and neuropsychology assessment. These children showed declines in all domains of neuropsychological functioning in the time leading up to surgery (all p-values ≤ 0.001; e.g., βFSIQ = -1.9, SEFSIQ = 0.3, pFSIQ < 0.001). Children lost on average one to four points per year, depending on the domain considered; 27-43% declined by 10 or more points from their first to their last preoperative assessment. At the time of presurgical evaluation, most children (46-60%) scored one or more standard deviations below the mean (<85) on the different neuropsychological domains; 37% of these met the threshold for intellectual disability (Full-Scale IQ < 70). On a group level, there was no change in performance from pre- to postoperative assessment on any of the domains (all p-values > 0.128). However, children who became seizure-free through surgery showed higher postoperative neuropsychological performance (e.g., rrb-FSIQ = 0.37, p < 0.001). These children continued to demonstrate improvements in neuropsychological functioning over the course of their long-term follow-up (e.g., βFSIQ = 0.9, SEFSIQ = 0.3, pFSIQ = 0.004). Children who had discontinued antiseizure medication (ASM) treatment at one-year follow-up showed an eight-to-13-point advantage in postoperative Working Memory, Processing Speed, and Numeracy, and greater improvements in Verbal IQ, Working Memory, Reading, and Spelling (all p-values < 0.034) over the postoperative period compared to children who were seizure-free and still receiving ASMs. In conclusion, by providing seizure freedom and the opportunity for ASM cessation, epilepsy surgery may not only halt but reverse the downward trajectory that children with drug-resistant epilepsy display in neuropsychological functioning. To halt this decline as soon as possible, or potentially prevent it from occurring in the first place, children with focal epilepsy should be considered for epilepsy surgery as early as possible after diagnosis.

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Section: Discussionmentioning

confidence: 99%

“…Low preoperative IQ should therefore not be taken as a contraindication to evaluation for epilepsy surgery. 73 …”

Section: Discussionmentioning

confidence: 99%

Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline?

Eriksson,

Prentice,

Piper

et al. 2024

Brain

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“…Various surgical treatments are widely recognized as beneficial options for reducing seizures [6][7][8]17,21]. However, given the potential risks and substantial economic burden associated with epilepsy surgery, the need to identify predictive factors of success prior to surgery is gaining importance [21][22][23]. To explore these predictive clinical factors, we compared the demographic characteristics and clinical factors of the patients who became seizure-free with those of the patients who did not.…”

Section: Discussionmentioning

confidence: 99%

Resective Epilepsy Surgery after Corpus Callosotomy in Children with Lennox-Gastaut Syndrome

Park,

Kwon,

Koo

et al. 2024

Ann Child Neurol

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Purpose: This study examined the characteristics and outcomes of resective epilepsy surgery following corpus callosotomy (CC) in children with Lennox-Gastaut syndrome (LGS).Methods: We retrospectively analyzed 17 children with LGS who underwent resective surgery (RS) after CC over a span of 10 years, with a minimum of 2 years of follow-up, at a single tertiary epilepsy center in Korea.Results: Of the 17 patients, 13 (73.5%) demonstrated favorable surgical outcomes (Engel class I or II) at 1 year after RS, and eight (47.1%) were ultimately free of seizures 2 years after surgery. A significantly larger decrease in the number of anti-seizure medications taken from before to 2 years after the final surgical procedure was observed in the group that became seizure-free than in the group with persistent seizures (<i>P</i>=0.062). Furthermore, a significantly greater decline in daily adaptive function was found in the persistent seizure group (<i>P</i>=0.059). The baseline characteristics, results of presurgical evaluation, and treatment-related factors assessed prior to surgery showed no significant differences between the seizure-free group and the group with persistent seizures.Conclusion: In conclusion, RS may be a viable option for patients with LGS who exhibit lateralization and/or localization on presurgical evaluation after CC, as the procedure may reveal a concealed primary focus. The proactive implementation of two-stage epilepsy surgery could provide significant seizure reduction and preservation of cognitive function in carefully selected patients with LGS.

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Section: Introductionmentioning

confidence: 99%

“…However, a large proportion of patients had a reduction in seizure frequency at long-term follow-up, indicating resective surgery as an important palliative potential for intellectual disability patients with epilepsy. 19,20 In general, uncontrolled epilepsy treatment outcome might result in a decrease quality of life, stigma in the community, physical injuries and increased mortality. 5,21,22 Some antiepileptic medications such as valproate also reduce cognitive abilities and performance levels in children.…”

Section: Introductionmentioning

confidence: 99%

Epilepsy Treatment Outcome and Its Predictors Among Children Who Had Chronic Follow Up at Dessie Comprehensive Specialized Hospital

Alene,

Engidaye,

Birhane

et al. 2024

PROM

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Introduction Epilepsy is a chronic non-communicable disease of the brain that affects millions of people worldwide. A significant number of children are affected globally, and most live in developing countries, often with physical and cognitive disabilities. Regardless of these factors, epilepsy is poorly controlled, particularly in the developing countries. Thus, this study aimed to assess the magnitude of treatment outcomes and its predictors among pediatrics patients with epilepsy who were followed-up at the Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Methods Hospital-based cross-sectional study was conducted from 1 June 2022 to 30 August 2022. A total of 200 patients with epilepsy were included in this study. Data were collected through face-to-face interviews, and by reviewing medical records. The collected data were entered into Epi-data version 4.6 and exported to SPSS version 25.0. Descriptive statistics such as frequencies, percentages, means and standard deviations were computed. Binary and multivariate logistic regression analyses were performed. Variables with p < 0.25 in bivariate analysis were entered into multivariable logistic regression. In multivariable analysis, adjusted odd ratio with 95% CI and p-value less than 0.05 were considered statistically significant. Results Of 200 pediatric patients with epilepsy, 66 (34.5%) had poor treatment outcomes. In the multivariate analysis, 11–15 years of age (AOR = 4.08; 95% CI = 1.202, 13.848), poor treatment adherence (AOR = 3.21; 95% CI = 1.421, 7.249), history of more seizure frequency before starting treatment (AOR = 4.19; 95% CI = 1.984, 8.834) and history of head injury (AOR = 3.03; 95% CI = 1.502, 6.112) were significantly associated with poor treatment outcomes in pediatric patients with epilepsy. Conclusion Significant proportion of pediatric patients with epilepsy had poor treatment outcomes. Therefore, health-care workers should strictly follow patient treatment especially for pediatric epileptic patients’ who have poor treatment adherence, more seizure frequency history, head injury history and whose age were 11–15 years old.

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Low IQ predicts worse long-term seizure outcome after resective epilepsy surgery – A propensity score matched analysis

Cited by 3 publications

References 32 publications

Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline?

Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline?

Resective Epilepsy Surgery after Corpus Callosotomy in Children with Lennox-Gastaut Syndrome

Epilepsy Treatment Outcome and Its Predictors Among Children Who Had Chronic Follow Up at Dessie Comprehensive Specialized Hospital

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