Cognitive performance in distinct groups of children undergoing epilepsy surgery-a single-centre experience

Barbora Benova; Anezka Belohlavkova; Petr Jezdik; Alena Jahodová; Martin Kudr; Vladimir Komarek; Vilem Novak; Petr Liby; Robert Lesko; Michal Tichý; Martin Kyncl; Josef Zamecnik; Pavel Krsek; Alice Maulisova

doi:10.7717/peerj.7790

Cognitive performance in distinct groups of children undergoing epilepsy surgery-a single-centre experience

PeerJ. 2019 Oct 8:7:e7790. doi: 10.7717/peerj.7790. eCollection 2019.

Authors

Barbora Benova^#^{1

2}, Anezka Belohlavkova^#^{1

2}, Petr Jezdik³, Alena Jahodová^{1

2}, Martin Kudr^{1

2}, Vladimir Komarek^{1

2}, Vilem Novak^{1

4}, Petr Liby⁵, Robert Lesko^{1

5}, Michal Tichý^{1

5}, Martin Kyncl^{1

6}, Josef Zamecnik^{1

7}, Pavel Krsek^{1

2}, Alice Maulisova⁸

Affiliations

¹ 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
² Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic.
³ Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University of Prague, Prague, Czech Republic.
⁴ Department of Paediatric Neurology, Ostrava Faculty Hospital, Ostrava, Czech Republic.
⁵ Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic.
⁶ Department of Radiology, Motol Universiy Hospital, Prague, Czech Republic.
⁷ Department of Pathology and Molecular Medicine, Motol University Hospital, Prague, Czech Republic.
⁸ Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic.

^# Contributed equally.

Abstract

Background: We aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing-pre-2011 vs. established-post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical).

Methods: We analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient's epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change.

Results: Epilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model.

Discussion: Post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients' potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.

Keywords: Cognitive outcome; Drug resistant epilepsy; Long-term epilepsy-associated tumours; Malformations of cortical development; Paediatric epilepsy surgery.

Grants and funding

This work was supported by MH—CZ DRO University Hospital Motol, Prague, Czech Republic (No. 00064203-6005) and by grant CZ.2.16/3.1.00/2402. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.