title: Postoperative electroencephalographic seizures are associated with deficits in executive function and social behaviors at 4 years of age following cardiac surgery in infancy.
abstract: OBJECTIVE
  The occurrence of an electroencephalographic (EEG) seizure after surgery for complex congenital heart defects has been associated with worse neurodevelopmental (ND) outcomes. We previously identified postoperative seizures documented by 48-hour EEG monitoring in 11% of 178 neonates and infants. Evaluation at 1 year of age did not identify an adverse effect of an EEG seizure on ND outcomes. The current study was undertaken to determine if testing in the preschool period would identify deficits that become apparent as children develop.
  
  
  METHODS
  The ND outcomes assessed at 4 years of age included cognition, language, attention, impulsivity, executive function, behavior problems, academic achievement, and visual and fine motor skills.
  
  
  RESULTS
  Developmental evaluations were performed in 132 (87%) of 151 survivors. For the entire cohort, the Full-Scale IQ was 95.0 ± 18.5. IQ was 95.1 ± 18.7 for patients without a history of seizure and 93.6 ± 16.7 for those with a history of seizure. After covariate adjustment, occurrence of an EEG seizure was associated with worse executive function (P = .037) and impaired social interactions/restricted behavior (P = .05). Seizures were not significantly associated with worse performance for cognition, language, attention, impulsivity, academic achievement, or motor skills (all P > .1).
  
  
  CONCLUSIONS
  The occurrence of a postoperative seizure is a biomarker of brain injury. This study confirms that postoperative EEG seizures are associated with worse ND outcomes, characterized by impairments of executive function and a higher prevalence of deficits in social interactions and repetitive/restricted behaviors in preschool survivors of cardiac surgery in infancy. However, EEG seizures were not associated with worse cognitive, language, or motor skills.
authors.affiliation: Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. gaynor@email.chop.edu
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Gail P
authors.initials: GP
authors.lastname: Jarvik
authors.forename: Marsha
authors.initials: M
authors.lastname: Gerdes
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Kim
authors.forename: Ramakrishnan
authors.initials: R
authors.lastname: Rajagopalan
authors.forename: Judy
authors.initials: J
authors.lastname: Bernbaum
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Robert R
authors.initials: RR
authors.lastname: Clancy
mesh_terms: D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D004569:Electroencephalography; D056344:Executive Function; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000209:etiology* / Q000503:physiopathology*; D011446:Prospective Studies; D012640:Seizures / Q000209:etiology* / Q000503:physiopathology*; D012919:Social Behavior