Long-term intellectual and developmental outcomes after pediatric epilepsy surgery: A systematic review and meta-analysis

被引:8
作者
Stefanos-Yakoub, Ilona [1 ]
Wingeier, Kevin [1 ,2 ]
Held, Ulrike [3 ]
Latal, Beatrice [4 ,5 ,6 ]
Wirrell, Elaine [7 ,8 ]
Smith, Mary Lou [9 ,10 ]
Ramantani, Georgia [1 ,5 ,6 ]
机构
[1] Univ Childrens Hosp Zurich, Dept Neuropediat, Steinwiesstr 75, CH-8032 Zurich, Switzerland
[2] Univ Childrens Hosp Zurich, Dept Psychosomat & Psychiat, Zurich, Switzerland
[3] Univ Zurich, Epidemiol Biostat & Prevent Inst, Dept Biostat, Zurich, Switzerland
[4] Univ Childrens Hosp Zurich, Child Dev Ctr, Zurich, Switzerland
[5] Univ Childrens Hosp Zurich, Childrens Res Ctr, Zurich, Switzerland
[6] Univ Zurich, Zurich, Switzerland
[7] Mayo Clin, Dept Neurol, Div Child & Adolescent Neurol, Rochester, MN USA
[8] Mayo Clin, Dept Neurol, Div Epilepsy, Rochester, MN USA
[9] Univ Toronto Mississauga, Dept Psychol, Toronto, ON, Canada
[10] Hosp Sick Children, Neurosci & Mental Hlth Program, Toronto, ON, Canada
关键词
children; cognitive functioning; development; focal lesional epilepsy; intelligence; ANTIEPILEPTIC DRUG-WITHDRAWAL; TUBEROUS SCLEROSIS COMPLEX; TEMPORAL-LOBE SURGERY; QUALITY-OF-LIFE; PRESCHOOL-CHILDREN; COGNITIVE-DEVELOPMENT; REFRACTORY EPILEPSY; RESISTANT EPILEPSY; SURGICAL-TREATMENT; CHILDHOOD;
D O I
10.1111/epi.17834
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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.
引用
收藏
页码:251 / 265
页数:15
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