Surgery of children with frontal lobe lesional epilepsy: neuropsychological study.
OBJECTIVE
was to provide new data about the evolution of neuropsychological findings in patients with lesional frontal lobe epilepsy (FLE) operated on with lesion excision.


METHODS
Twelve patients with lesional FLE underwent full clinical examination including neurological, neuropsychological and developmental assessments, high-resolution magnetic resonance imaging (MRI), ictal and interictal prolonged EEG monitoring and evaluation of seizure semeiology before and after surgery. The mean follow-up duration was 2 years and 10 months (range=14 months-7 years). Another group of lesional temporal lobe epilepsy, matched for the age at surgery and side of surgery, was likewise studied in order to compare neuropsychological patterns and to try to find out specific features in frontal lobe epilepsy evolution.


RESULTS
All patients resulted seizure free at outcome except one belonging to Engel's class II. Before surgery general intelligence was similar in FLE as well as in TLE group. Executive functions and motor coordination were frequently affected in FLE whereas patients with TLE often presented with deficits in naming, visual memory and visuo-spatial attention. After surgery there was a frequent decline of IQ in FLE group together with a slight deterioration, especially of executive functions in some patients. An improvement of behaviour was often observed in both groups.


CONCLUSIONS
As already reported in literature, neuropsychological pre-surgical data confirms the involvement of attention and executive functions in lesional FLE. No significant neuropsychological improvement was produced by surgery that determined in some cases a slight decline of general intelligence and specific frontal abilities. Yet, generally behaviour improved and seizures were controlled.
Chieffo
Daniela
D
Child Neurology and Psychiatry Unit, Catholic University, Largo Gemelli 8, Rome, Italy.
Lettori
Donatella
D
Contaldo
Ilaria
I
Perrino
Francesca
F
Graziano
Alessandra
A
Palermo
Concetta
C
Mittica
Antonio
A
Tamburrini
Giampiero
G
Battaglia
Domenica
D
Di Rocco
Concezio
C
Guzzetta
Francesco
F
D000293:Adolescent; D001288:Attention; D001519:Behavior / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D017034:Epilepsy, Frontal Lobe / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D056344:Executive Function; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000502:physiology / Q000601:surgery; D006801:Humans; D007223:Infant; D007360:Intelligence; D008297:Male; D009483:Neuropsychological Tests; D016896:Treatment Outcome