Improvement of Brain Function After Surgery in Infants with Posterior Quadrant Cortical Dysplasia
Abstract number :
2.266
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2021
Submission ID :
1825590
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Riyo Ueda, MD, PhD - National Institute of Mental Health, National Center of Neurology and Psychiatry; Masaki Iwasaki, Dr. - Department of Neurosurgery - National Center Hospital, National Center of Neurology and Psychiatry; Yosuke Kita, PhD - Department of Developmental Disorders - National Institute of Mental Health, National Center of Neurology and Psychiatry; Hiroshige Takeichi, PhD - Department of Developmental Disorders - National Institute of Mental Health, National Center of Neurology and Psychiatry; Takashi Saito, Dr. - Department of Child Neurology - National Center Hospital, National Center of Neurology and Psychiatry; Eiji Nakagawa, Dr. - Department of Child Neurology - National Center Hospital, National Center of Neurology and Psychiatry; Kenji Sugai, Dr. - Department of Child Neurology - National Center Hospital, National Center of Neurology and Psychiatry; Takashi Okada, Dr. - Department of Developmental Disorders - National Institute of Mental Health, National Center of Neurology and Psychiatry; Masayuki Sasaki, Dr. - Department of Child Neurology - National Center Hospital, National Center of Neurology and Psychiatry
Rationale: Infants with posterior quadrant dysplasia (PQD) often develop epilepsy under the age of 1 year and present severe epileptic encephalopathy. However, it is difficult to evaluate accurately the development of considerably delayed infants. In this study, to reveal whether neurodevelopmental outcome of infants after epilepsy surgery can be quantitatively assessed by electroencephalography (EEG) functional connectivity analysis.
Methods: We enrolled 13 infants with posterior quadrant dysplasia aged < 2 years who were treated using posterior quadrantectomy and 21 age-matched infants. EEG was performed both before and one year after surgery. Developmental quotient (DQ) was assessed both before and 3 years after surgery. The phase lag index (PLI) was calculated as indices of brain connectivity for three different frequency ranges of each EEG epoch: alpha (8–13 Hz), beta (13–30 Hz), and gamma (30–40 Hz). PLI of three different pairs of electrodes in the nonsurgical hemisphere, i.e., the anterior short distance (ASD), posterior short distance (PSD), and long distance (LD) pairs, were selected. The relationship between the PLI and DQ was evaluated.
Results: Overall, 77% of infants experienced seizure freedom after surgery. The DQ 3 years after surgery was 50.0 on average.
Figure 1 shows the results in which quadrantectomy modified contralateral healthy brain function after quadrantectomy. Quadrantectomy afforded the following improvements: (ⅰ) the beta- and gamma-band PSD-PLI on the nonsurgical side were higher preoperatively and were normalized to the control level after surgery; (ⅱ) the beta-band ASD-PLI on the nonsurgical side was higher preoperatively and was also normalized after surgery when compared with the right but not left side of the controls; (iii) the beta-band LD-PLI on the nonsurgical side was higher preoperatively and was also normalized after surgery when compared with the left but not right side of the controls; (iv) the alpha-band LD-PLI was lower preoperatively, and was also normalized after surgery when compared with the right but not left side of the controls;
Figure 2 identified a relationship between the alteration of brain function and improved development. A high preoperative DQ was associated with a high beta LD-PLI. On the other hand, a high postoperative DQ was associated with a high beta ASD-PLI.
Conclusions: PLI-PSD connectivity on the nonsurgical side was higher in the beta and gamma range in the presurgery vs. the control group, whereas PLI connectivity in the postsurgery group improved to the level of the control group after surgery. Infants with PQD exhibited developmental improvement after surgery. Patients with an improved postoperative long-term DQ were more likely to retain ASD-PLI postoperatively.
Funding: Please list any funding that was received in support of this abstract.: This abstract was supported by the Meiji Yasuda Mental Health Foundation, Japan (grant number 2020-1-007 to R.U.).
Surgery