Cognitive changes following surgery in intractable hemispheric and sub-hemispheric pediatric epilepsy.
OBJECTIVE
The objectives were to study the short and longitudinal changes in the cognitive skills of children with intractable epilepsy after hemispheric/sub-hemispheric epilepsy surgery.


METHODS
Sixteen patients underwent surgery from September 2005 until March 2009. They underwent detailed presurgical evaluation of their cognitive skills and were repeated annually for 3 years.


RESULTS
Their mean age was 6.6 years. Epilepsy was due to Rasmussen's encephalitis (n = 9), Infantile hemiplegia seizure syndrome (n = 2), hemimegalencephaly (n = 2), and Sturge Weber syndrome (n = 3). Fourteen (87.5%) patients underwent peri-insular hemispherotomy and two (12.5%) underwent peri-insular posterior quadrantectomy. The mental and social age, gross motor, fine motor, adaptive, and personal social skills showed a steady increase after surgery (p < 0.05). Language showed positive gains irrespective of the side and etiology of the lesion (p = 0.003). However, intelligence quotient (IQ) remained static on follow-up. Patients with acquired pathology gained more in their mental age, language, and conceptual thinking. Age of seizure onset and duration of seizures prior to surgery were predictive variables of postoperative cognitive skills.


CONCLUSIONS
There are short- and long-term gains in the cognitive skills of children with intractable epilepsy after hemispherotomy and posterior quadrantectomy that was better in those patients with acquired diseases. Age of seizure onset and duration of seizures prior to surgery were independent variables that predicted the postoperative outcome.
Thomas
Santhosh George
SG
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Daniel
Roy Thomas
RT
Chacko
Ari George
AG
Thomas
Maya
M
Russell
Paul Swamidhas Sudhakhar
PS
D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology* / Q000209:etiology*; D004827:Epilepsy / Q000150:complications* / Q000601:surgery*; D005260:Female; D038421:Hemispherectomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D016896:Treatment Outcome