Abstracts

Rationale: There is dearth of literature examining neuropsychological (NP) outcomes in children with DNET. Aims were to 1) conduct a systematic literature review of NP outcomes after epilepsy surgery for DNET, and 2) present NP results from a case series of children with DNET using reliable change methodology. Methods: A systematic review of all studies on DNET that included neuropsychological (NP) or cognitive outcomes was conducted. The case series involved a retrospective review of surgical patients seen at Alberta Children s Hospital with DNET diagnoses confirmed by pathology. The NP assessment included measures of intellectual functioning (IQ), visual-spatial abilities, verbal and visual memory, and questionnaires examining executive and adaptive functioning, attention, and quality of life (QOL). Reliable change indexes and qualitative methods were used to examine post-surgical NP changes in functioning. Results: Of 50 studies including DNET cases, only 7 studies included information on cognitive outcomes in children. No studies included a comprehensive evaluation of NP functioning. Overall, studies reported low average to average IQ in children with DNET. Engel Class I seizure outcome was approximately 85%. Few cognitive changes were reported post-surgery, aside from some improvements in psychological functioning. Case Series: A retrospective review identified 7 children (3 boys, 4 girls) with DNET, ranging from 3.7-16.4 (mean = 11.27) years of age at the pre-surgical NP evaluation. Mean age at seizure onset was 10.19 years. The duration of epilepsy was less than 1 year in five children, and greater than 2 years in two children. Complex partial seizures were most common and seizure frequency was approximately 6 seizures/week. Time to post-surgical follow-up ranged from 0.7-2.7 years. At follow-up, 6/7 children were seizure free and 2 children were no longer taking antiepileptic medication. Their full-scale IQ ranged from 56-99 pre-surgically (average=85.86) to 75-108 post-surgically (average=89). Pre-surgically, children demonstrated low average to average functioning on most NP measures, but attention and executive functioning problems were prevalent in 3-4 of the cases. Post-surgically, there was little change in functioning with the exception of two cases. One child suffered a stroke post-surgically and demonstrated reliable declines in 7/9 NP tests. Another child who had English as his second language demonstrated post-surgical reliable improvements on 6/9 NP tests. The remaining 5 children demonstrated little reliable change post-surgically. Qualitatively, executive functioning, adaptive functioning, and QOL improved in over half of children. Conclusions: Findings from this systematic review and small case series indicate that children with DNET demonstrate largely average NP functioning pre-surgically and few declines after surgery. Improvements in executive skills, adaptive functioning and QOL are reported in a substantial proportion of children after surgery.