Abstracts

Rationale: Previous studies have documented risk of some types of cognitive deficits (such as diminished language functions) in those undergoing dominant frontal resections. In one previous study, subtle language deficits were observed in some pediatric patients who underwent dominant frontal resection, while their behavior remained stable. However, little is known about the behavioral outcome of pediatric epilepsy patients undergoing nondominant frontal topectomy (NDFT).Methods: The records of nine patients (three females, six males) aged 4 to 13 years who underwent nondominant frontal topectomy for intractable seizures were reviewed. Because many patients were young or evidenced impaired intellectual ability at the time of surgery, most were unable to complete a comprehensive neuropsychological test battery pre- or postoperatively. IQ ranged from 43 to 104, with only two patients evidencing Full Scale IQ above 74 at the time of surgery. Patients underwent follow-up neuropsychological evaluation at a mean postoperative interval of 22 months (range 3 months to five years, 9 months). Records of parent report in the interview situation were reviewed to assess for any postoperative behavior changes.Results: Two patients who underwent surgery at preschool age displayed age-appropriate attentional abilities preoperatively, but postoperatively met criteria for ADHD on the basis of formal evaluation; family history was positive for ADHD in both of these children. The remaining seven patients displayed mild or greater ADHD symptoms at baseline. Of these, ADHD symptom severity remained stable in four patients and was improved in one patient (seen five years postoperatively). The remainining two patients were reported to experience reduced impulse control and judgment characterized by unusually mischievous behavior. Examples of problem behaviors included making marks on furniture or walls, dumping out bath soap, cutting own hair in school, and punching nails into paint cans. One of these patients also displayed reduced frustration tolerance and mood changes postoperatively, being described as either happy or mad. Diminished judgment that required increased supervision relative to baseline was largely resolved by adolescence in both of these patients who underwent surgery at 7 and 9 years of age.Conclusions: Although most patients display stable behavioral functioning postoperatively, a minority appear to experience a marked postoperative decline in judgment and impulse control that appears to eventually resolve with maturation. Parents of children who undergo NDFT should be forewarned that behavior changes that appear to be largely temporary may require considerable adult supervision for several years postoperatively.