Authors :
Itay Tokatly Latzer, MD – Boston Children's Hospital
Jeffrey Bolton, MD – Boston Childrens Hospital
Scellig Stone, MD, PhD – Boston Childrens Hospital & Harvard Medical School
Dana Martino, BS – Boston Children's Hospital
Giovanna Stefanini, BS – Boston Children's Hospital
Michelle Chiu, MD – Boston Children's Hospital
Phillip Pearl, MD – Boston Children's Hospital & Harvard Medical School
Presenting Author: Alyssa Ailion, PhD – Boston Children's Hospital & Harvard Medical School
Rationale:
Frontal lobe epilepsy (FLE), the second most common focal epilepsy, is often linked to deficits in attention, executive function, and memory. Despite accounting for ~25% of pediatric resective epilepsy surgeries, neuropsychological outcomes following frontal lobe resections in children are poorly documented. This study aimed to comprehensively describe these outcomes in a large pediatric cohort.
Methods:
In this single-centered prospective study, we assessed the pre- and postoperative full-scale IQ, language, adaptive skills, attention/working memory, executive functions, memory, behavior, and visuomotor and motor functions of children who underwent epilepsy surgery in their frontal lobe. Clinically significant postoperative cognitive changes were determined using a cutoff of greater than 1.5 Z-score change. We examined demographic, epilepsy-related, and neurosurgical parameters for associations with postoperative cognitive change.
Results:
The study included 78 children (51% girls; median age at surgery, 7.1 years [IQR, 4.2-13.5]) who underwent pre- and postoperative neuropsychological assessments (median interval, 2.5 years [IQR, 1.6-4.5]; range, 0.5-13 years). A longer duration between the pre- and post-neuropsychological assessments correlated with improved executive functions (R=0.351, p=0.02). Overall, 38% of patients experienced unchanged outcomes, 26% showed improvement without decline, 24% declined without improvement, and 12% exhibited mixed changes. Increased preoperative seizures and an abundant EEG interictal frequency were associated with declines across several measures. A shorter duration from epilepsy diagnosis to surgery was associated with broad neuropsychological improvement. Intracranial monitoring before surgery was associated with improved visuomotor outcomes (p=0.04). LITT for mesial lesions correlated with improved cognitive, language, adaptive, and memory outcomes (p=0.04). Tumor etiology was linked to improved full-scale IQ and language (p=0.05), whereas autoimmune etiology correlated with behavioral decline (p=0.01). Postoperative seizure freedom and reduction or weaning of antiseizure medications were associated with broad improvements.
Conclusions:
Our analysis of data from a large sample of children who underwent frontal lobe epilepsy surgery indicates generally favorable neuropsychological outcomes up to 13 years post-surgery. The majority of children (64%) had either stable or improved post-surgical neuropsychological functioning. Factors associated with greater neuropsychological recovery included shorter time to surgery, longer duration from surgery, and less invasive surgical approaches (i.e., LITT). Future research is needed to understand cognitive findings in the setting of brain changes and specifically: 1) identify modifiable factors that alter frontal brain networks prior to surgery 2) methods to maximize post-operative frontal reorganization and recovery.
Funding: No funding was received for this study.