Abstracts

Rationale: Children with epilepsy have deficits in executive function (EF), but there is limited data following epilepsy surgery on EF outcomes. Our study examines EF pre- and post-surgical intervention in children with focal epilepsy.Methods: Twenty children (14 males, 6 females) with intractable epilepsy were evaluated pre-and post-surgery in an ongoing clinical study. Neuropsychological evaluations were conducted prior to surgery (Mean Age=8.77±3.84; AEDs=2.37±.761) to obtain a baseline of cognitive functioning. Postsurgical evaluations (Mean Age=12.25±4.38, AEDs=1.65±1.18) occurred an average of 2 years (range=6 months-4.6 years) after resection. Area of lesionectomy included: temporal (Left: 8, Right: 4), parietal (Left: 2, Right: 2), frontal (Left: 1, Right: 2), and occipital (Right: 1). Sixty percent of children obtained seizure freedom post-surgery. Measures included parent ratings of EF (Behavior Rating Index of Executive Functioning (BRIEF)) and attention (ADHD Rating Scale (ARS) and Child Behavior CheckList (CBCL)), as well as a direct measure of attention (WISC-IV Digit Span (DS)). Repeated measures analysis of variance (ANOVA), linear regression and reliable change indices (RCI) were conducted.Results: Repeated measures analyses revealed that behavior regulation skills (BRI) on the BRIEF improved pre- to post-surgery (p=.02), with post-hoc analysis showing that the BRIEF Emotional Control (EC) subscale was the primary area of change. RCI at 90% CI revealed that 44% of children had clinically meaningful decrease in BRI, while 55% of children changed on EC. Controlling for age, EC post-surgery was correlated with CBCL externalizing problems subscale (r=.732, p=.001), which also decreased pre- to post-surgery (p=.02) with 30% having a reduction from the clinical or at-risk range (T≥60) to nonclinical range (T<60) for externalizing behaviors. EC did not significantly correlate with other factors (number of AEDs, internalizing problems, seizure freedom). Cognitive functioning on all other measures (IQ, ARS, DS) remained stable with no significant changes.Conclusions: Our findings demonstrated significant improvements in behavioral regulation aspects of EF after a fairly short post-surgical follow-up period, particularly for emotional control and externalizing behavior. A decrease in BRI and EC suggests better ability to shift cognitive set and monitor emotional responses in daily life. In contrast, cognitive regulation aspects of EF, attention, and IQ were not significantly different from pre- to post-surgery, which is consistent with previous literature. Post-surgical improvements with emotion and behavior regulation may be related to overall improvement as a result of better seizure control, less disrupted sleep, fewer medications, or less emotional stress on the family. Regardless of seizure control, improvement in this area is a potential positive side effect of surgery. Longer follow-up is needed to determine if other EF aspects show improvements over time or if those functions are less impacted by surgical intervention.