Objective

To use reliable change indices (RCIs) developed specifically for pediatric patients with epilepsy to examine cognitive outcomes after frontal lobe resection for pharmacoresistant epilepsy.

Methods

Forty-one pediatric patients (25 male, M_age = 10 years) completed comprehensive neuropsychological evaluations before and an average of 6.5 months after frontal lobe resections for treatment of epilepsy. Evaluations included tests of intelligence, attention/working memory, processing speed, language, visuospatial skills, executive function, and episodic memory. Practice effect-adjusted RCIs were used to determine clinically significant postoperative cognitive change. Demographic, disease, and surgical variables were examined to identify factors associated with postoperative cognitive decline or improvement.

Results

Within each cognitive domain, there was a large proportion of patients (51–84%) who did not exhibit significant cognitive change. In terms of overall cognitive profile, 44% demonstrated improvement in at least one domain and 69% declined in at least one domain. Postoperative cognitive improvement occurred most commonly in the domain of processing speed, whereas postoperative cognitive decline occurred most frequently in the domain of visuospatial skills. Younger age at surgery was associated with cognitive improvement. Older age at seizure onset and higher baseline cognitive performance were associated with cognitive decline.

Significance

Approximately 6.5 months after frontal lobe resection, only 15% of our sample showed stable performance across all cognitive domains. Seventeen percent of patients showed improvements without declines, 42% showed declines without improvements, and 27% showed a mix of improvements and declines across different cognitive domains. Age and baseline abilities were associated with postoperative cognitive change on multiple measures. With 1 in 8 children demonstrating postoperative decline across three or more domains, further research is needed to identify factors associated with cognitive decline in order to inform clinical decision-making and patient/family counseling.

中文翻译：

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额叶切除术治疗儿童和青少年癫痫后的认知结果

客观的

使用专为儿科癫痫患者开发的可靠变化指数 (RCI) 来检查药物耐药性癫痫额叶切除术后的认知结果。

方法

41 名儿科患者（25 名男性，M_年龄 = 10 岁）在额叶切除术治疗癫痫之前和之后平均 6.5 个月完成了全面的神经心理学评估。评估包括智力、注意力/工作记忆、处理速度、语言、视觉空间技能、执行功能和情景记忆的测试。实践效果调整的 RCI 用于确定具有临床意义的术后认知变化。检查人口统计学、疾病和手术变量，以确定与术后认知能力下降或改善相关的因素。

结果

在每个认知领域内，有很大比例的患者 (51-84%) 没有表现出显着的认知变化。在整体认知状况方面，44% 的人至少在一个领域有所改善，69% 的人至少在一个领域有所下降。术后认知改善最常发生在处理速度领域，而术后认知下降最常发生在视觉空间技能领域。手术时年龄较小与认知改善有关。癫痫发作时年龄较大和基线认知能力较高与认知能力下降有关。

意义

额叶切除术后大约 6.5 个月，只有 15% 的样本在所有认知领域表现出稳定的表现。17% 的患者表现出改善但没有下降，42% 表现出下降但没有改善，27% 的患者在不同的认知领域表现出改善和下降的混合。年龄和基线能力与术后认知改变有关。由于八分之一的儿童在三个或更多领域表现出术后下降，需要进一步研究以确定与认知下降相关的因素，以便为临床决策和患者/家庭咨询提供信息。