Authors :
Presenting Author: Hope Reecher, BS – Froedtert and the Medical College of Wisconsin
Sydney Park, PhD – Pediatric Neuropsychology Postdoctoral Fellow, Department of Neurology, Froedtert and the Medical College of Wisconsin; Madison Berl, PhD – Neuropsychologist, Department of Neurology, Children's National Hospital; Alyssa Ailion, PhD – Neuropsychologist, Department of Psychiatry and Neurology, Boston Children's Hospital; Jennifer Koop, PhD, ABPP – Neuropsychologist, Department of Neurology, Froedtert and the Medical College of Wisconsin
Rationale:
Surgery, definitive or palliative, is a standard treatment option for refractory seizures. Pre-operative evaluation includes neuropsychology assessment to identify cognitive profiles and risk for post-surgical decline. The MCW Cognitive Lateralization Rating Index (CLRI) quantifies the degree of dysfunction evident on neuropsychological assessment of dominant/language versus nondominant/visual-spatial functions.1 Combining the CLRI with seizure history can suggest atypical brain functional organization in the case of the “crowding hypothesis” if dominant skills remain intact despite left hemisphere seizure foci. We hypothesize that congruent dominant-hemisphere CRLI and seizure foci may result in altered surgical plan to preserve function. This study investigated if there was a difference in surgery rate and type per CLRI category.
Methods:
Data was extracted from the national Pediatric Epilepsy Research Consortium (PERC) database of patients presented at institutional epilepsy surgery conferences. Patients with neuropsychological data in all CLRI domains were categorized for analyses; those with left-hemisphere seizure foci and non-dominant CLRI were re-categorized as ‘reorganized’. Frequencies and descriptive statistics were run on demographic and surgical variables (Table 1), with X2 test of independence for CLRI and surgical variables.
Results:
Of 114 patients with CLRI scores (Table 2), 57 were offered surgery. A total of 61% of patients had left-hemisphere seizure foci. Chi-square analysis between surgery offered and initial CLRI was not significant (X2 (2, 114) = 5.1, p = 0.08). When including reorganization category, results were statistically significant (X2 (3, 114) = 18.2, p = < 0.001). All reorganized patients were offered surgery and were more likely to undergo left-hemispheric surgery (92%;