TY - JOUR
T1 - Long-term intellectual and developmental outcomes after pediatric epilepsy surgery
T2 - A systematic review and meta-analysis
AU - Stefanos-Yakoub, Ilona
AU - Wingeier, Kevin
AU - Held, Ulrike
AU - Latal, Beatrice
AU - Wirrell, Elaine
AU - Smith, Mary Lou
AU - Ramantani, Georgia
N1 - Publisher Copyright:
© 2023 International League Against Epilepsy.
PY - 2024/2
Y1 - 2024/2
N2 - In addition to the primary aim of seizure freedom, a key secondary aim of pediatric epilepsy surgery is to stabilize and, potentially, optimize cognitive development. Although the efficacy of surgical treatment for seizure control has been established, the long-term intellectual and developmental trajectories are yet to be delineated. We conducted a systematic review and meta-analysis of studies reporting pre- and postsurgical intelligence or developmental quotients (IQ/DQ) of children with focal lesional epilepsy aged ≤18 years at epilepsy surgery and assessed at >2 years after surgery. We determined the IQ/DQ change and conducted a random-effects meta-analysis and meta-regression to assess its determinants. We included 15 studies reporting on 341 patients. The weighted mean age at surgery was 7.1 years (range =.3–13.8). The weighted mean postsurgical follow-up duration was 5.6 years (range = 2.7–12.8). The overall estimate of the mean presurgical IQ/DQ was 60 (95% confidence interval [CI] = 47–73), the postsurgical IQ/DQ was 61 (95% CI = 48–73), and the change was +.94 IQ/DQ (95% CI = −1.70 to 3.58, p =.486). Children with presurgical IQ/DQ ≥ 70 showed a tendency for higher gains than those with presurgical IQ/DQ < 70 (p =.059). Higher gains were determined by cessation of antiseizure medication (ASM; p =.041), not just seizure freedom. Our findings indicate, on average, stabilization of intellectual and developmental functioning at long-term follow-up after epilepsy surgery. Once seizure freedom has been achieved, ASM cessation enables the optimization of intellectual and developmental trajectories in affected children.
AB - In addition to the primary aim of seizure freedom, a key secondary aim of pediatric epilepsy surgery is to stabilize and, potentially, optimize cognitive development. Although the efficacy of surgical treatment for seizure control has been established, the long-term intellectual and developmental trajectories are yet to be delineated. We conducted a systematic review and meta-analysis of studies reporting pre- and postsurgical intelligence or developmental quotients (IQ/DQ) of children with focal lesional epilepsy aged ≤18 years at epilepsy surgery and assessed at >2 years after surgery. We determined the IQ/DQ change and conducted a random-effects meta-analysis and meta-regression to assess its determinants. We included 15 studies reporting on 341 patients. The weighted mean age at surgery was 7.1 years (range =.3–13.8). The weighted mean postsurgical follow-up duration was 5.6 years (range = 2.7–12.8). The overall estimate of the mean presurgical IQ/DQ was 60 (95% confidence interval [CI] = 47–73), the postsurgical IQ/DQ was 61 (95% CI = 48–73), and the change was +.94 IQ/DQ (95% CI = −1.70 to 3.58, p =.486). Children with presurgical IQ/DQ ≥ 70 showed a tendency for higher gains than those with presurgical IQ/DQ < 70 (p =.059). Higher gains were determined by cessation of antiseizure medication (ASM; p =.041), not just seizure freedom. Our findings indicate, on average, stabilization of intellectual and developmental functioning at long-term follow-up after epilepsy surgery. Once seizure freedom has been achieved, ASM cessation enables the optimization of intellectual and developmental trajectories in affected children.
KW - children
KW - cognitive functioning
KW - development
KW - focal lesional epilepsy
KW - intelligence
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U2 - 10.1111/epi.17834
DO - 10.1111/epi.17834
M3 - Review article
C2 - 38031640
AN - SCOPUS:85178934523
SN - 0013-9580
VL - 65
SP - 251
EP - 265
JO - Epilepsia
JF - Epilepsia
IS - 2
ER -