title: Impact of epilepsy surgery on development of preschool children: identification of a cohort likely to benefit from early intervention.
abstract: OBJECTIVE
  Outcomes of focal resection in young children with early-onset epilepsy are varied in the literature due to study differences. In this paper, the authors sought to define the effect of focal resection in a small homogeneous sample of children who were otherwise cognitively intact, but who required early surgical treatment. Preservation of and age-appropriate development of intelligence following focal resection was hypothesized.
  
  
  METHODS
  Cognitive outcome after focal resection was retrospectively reviewed for 15 cognitively intact children who were operated on at the ages of 2-6 years for lesion-related, early-onset epilepsy. Intelligence was tested prior to and after surgery. Effect sizes and confidence intervals for means and standard deviations were used to infer changes and differences in intelligence between 1) groups (pre vs post), 2) left versus right hemisphere resections, and 3) short versus long duration of seizures prior to resection.
  
  
  RESULTS
  No group changes from baseline occurred in Full Scale, verbal, or nonverbal IQ. No change from baseline intelligence occurred in children who underwent left or right hemisphere surgery, including no group effect on verbal scores following surgery in the dominant hemisphere. Patients with seizure durations of less than 6 months prior to resection showed improvement from their presurgical baseline in contrast to those with seizure duration of greater than 6 months prior to surgery, particularly in Wechsler Full Scale IQ and nonverbal intelligence.
  
  
  CONCLUSIONS
  This study suggests that surgical treatment of focal seizures in cognitively intact preschool children is likely to result in seizure remediation, antiepileptic drug discontinuation, and no significant decrement in intelligence. The latter finding is particularly significant in light of the longstanding concern associated with performing resections in the language-dominant hemisphere. Importantly, shorter seizure duration prior to resection can result in improved cognitive outcome, suggesting that surgery for this population should occur sooner to help improve intelligence outcomes.
authors.affiliation: Departments of 1 Neurology.|Psychiatry, Seattle Children's Hospital;
authors.forename: Hillary A
authors.initials: HA
authors.lastname: Shurtleff
authors.affiliation: Health Informatics, Group Health, Seattle, Washington; and.
authors.forename: Dwight
authors.initials: D
authors.lastname: Barry
authors.affiliation: Psychiatry, Seattle Children's Hospital;
authors.forename: Timothy
authors.initials: T
authors.lastname: Firman
authors.affiliation: Departments of 1 Neurology.|Psychiatry, Seattle Children's Hospital;
authors.forename: Molly H
authors.initials: MH
authors.lastname: Warner
authors.affiliation: Hospital Escuela Universitario, UNAH, Tegucigalpa, Honduras.
authors.forename: Rafael L
authors.initials: RL
authors.lastname: Aguilar-Estrada
authors.affiliation: Departments of 1 Neurology.|Pediatrics, and.
authors.forename: Russell P
authors.initials: RP
authors.lastname: Saneto
authors.affiliation: Departments of 1 Neurology.|Pediatrics, and.
authors.forename: John D
authors.initials: JD
authors.lastname: Kuratani
authors.affiliation: Neurological Surgery, University of Washington School of Medicine;
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.affiliation: Departments of 1 Neurology.|Pediatrics, and.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Novotny
authors.affiliation: Neurological Surgery, University of Washington School of Medicine;
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Ojemann
mesh_terms: D017668:Age of Onset; D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000517:prevention & control*; D003131:Combined Modality Therapy; D002658:Developmental Disabilities / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D004292:Dominance, Cerebral; D061345:Early Medical Intervention; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000601:surgery; D005260:Female; D005625:Frontal Lobe / Q000601:surgery; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D007360:Intelligence; D007361:Intelligence Tests; D007806:Language Disorders / Q000517:prevention & control; D008297:Male; D012189:Retrospective Studies; D015173:Supratentorial Neoplasms / Q000150:complications / Q000601:surgery; D013702:Temporal Lobe / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants
keywords: AED = antiepileptic drug; DNET = dysembryoplastic neuroepithelial tumor; FSIQ = Wechsler Full Scale IQ; MTS = mesial temporal sclerosis; outcome; pediatric epilepsy; surgery