Abstracts

Rationale: Behavioral and cognitive problems are frequently reported in children with epilepsy. There is conflicting evidence if better seizure control following epilepsy surgery leads to improvement in behavior and cognition.This study aims to report the behavioral and cognitive outcomes following epilepsy surgery in children. Secondary aims include identifying the predictive factors that determine these functional outcomes. Methods: We retrospectively reviewed 126 patients below the age of 18 years who underwent epilepsy surgery for medically refractory epilepsy between January 2009 to December 2016. A minimum of 6 months of post- surgery follow up was required. Baseline clinical, imaging, and surgical data were collected.The primary outcome measure was the Impact of Childhood Neurologic Disability Scale (ICNDS) completed by parents which assesses  behavior, cognition and physical/neurological disability and epilepsy. The ICNDS scores were measured preoperatively and postoperatively at 6, 12, and 24 months.Separate linear mixed effects models were constructed to identify predictors of post-operative ICNDS total score and sub scores over time. Results: Of the 126 patients, 62.7% were male. Median duration of epilepsy was 4.7 years. Eighty-eight patients (69.8%) were seizure-free by the 2-year follow-up. Of the 126 patients, post-operative ICNDS scores were available for 103 patients (81.8%) at 6 months and 54 (42.9%) patients at 24 months.Average preoperative total ICNDS score was 55.7 ± 28.3. There was a significant post-operative improvement (reduction) of the ICNDS score at 6 months (total score: 34.6 ± 25.8, p<0.001) and 24 months (32.1±23.4, P<0.001)Behavior, cognition and epilepsy subscores also improved significantly from pre- to 6 months post-operatively (mean improvement of 6.1 points, p<0.001; 3.9 points, p<0.001; and 6.7 points, p<0.001, respectively) and remained consistent through 24 months. Improvement was observed even in patients who were not seizure-free after surgery (mean improvement of 22.0 and 22.1 points in total score at 6 months and 24 months, respectively, p<0.001 for both)Significant predictors of improved ICNDS total scores and subscores included absence of associated comorbidities or mood diagnoses (autism, ADHD anxiety and depression), tumor pathology, and seizure freedom at 2 years. Multilobar resection was predictive of improvement in cognition subscores. Duration and type of epilepsy, number of AEDs, and lobe of surgery were not predictive of improved ICNDS scores. Conclusions: After pediatric epilepsy surgery, there is a sustained improvement in behavior and cognition, as perceived by the families, regardless of seizure freedom status after surgery.We do not know the impact of external factors such as the social, economic, and educational factors on these results. Future studies are needed to clarify if these findings are sustained at 5-10 years follow up, and if a negative cognitive/behavioral outcome will have an effect on employment once these children reach adulthood. Funding: None