Impact of severe epilepsy on development: Recovery potential after successful early epilepsy surgery

被引:59
作者
Roulet-Perez, Eliane [1 ]
Davidoff, Veronique
Mayor-Dubois, Claire
Maeder-Ingvar, Malin [2 ]
Seeck, Margitta [3 ]
Ruffieux, Christiane [4 ]
Villemure, Jean-Guy [5 ]
Deonna, Thierry
机构
[1] CHU Vaudois, Pediat Neurol & Neurorehabil Unit, Dept Pediat, CH-1011 Lausanne, Switzerland
[2] CHU Vaudois, Dept Neurol, CH-1011 Lausanne, Switzerland
[3] Hop Univ Genevois, Dept Neurol, Geneva, Switzerland
[4] CHU Vaudois, Inst Univ Med Sociale & Prevent, CH-1011 Lausanne, Switzerland
[5] CHU Vaudois, Dept Neurosurg, CH-1011 Lausanne, Switzerland
关键词
Epilepsy; Epilepsy surgery; Development; Neuropsychology; Child; CORTICAL DEVELOPMENT; CHILDREN; HEMISPHEROTOMY; MALFORMATIONS; CONSEQUENCES; DISORDERS; CORTEX; BRAIN;
D O I
10.1111/j.1528-1167.2009.02487.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
P>Purpose: Epilepsy surgery in young children with focal lesions offers a unique opportunity to study the impact of severe seizures on cognitive development during a period of maximal brain plasticity, if immediate control can be obtained. We studied 11 children with early refractory epilepsy (median onset, 7.5 months) due to focal lesion who were rendered seizure-free after surgery performed before the age of 6 years. Methods: The children were followed prospectively for a median of 5 years with serial neuropsychological assessments correlated with electroencephalography (EEG) and surgery-related variables. Results: Short-term follow-up revealed rapid cognitive gains corresponding to cessation of intense and propagated epileptic activity [two with early catastrophic epilepsy; two with regression and continuous spike-waves during sleep (CSWS) or frontal seizures]; unchanged or slowed velocity of progress in six children (five with complex partial seizures and frontal or temporal cortical malformations). Longer-term follow-up showed stabilization of cognitive levels in the impaired range in most children and slow progress up to borderline level in two with initial gains. Discussion: Cessation of epileptic activity after early surgery can be followed by substantial cognitive gains, but not in all children. In the short term, lack of catch-up may be explained by loss of retained function in the removed epileptogenic area; in the longer term, by decreased intellectual potential of genetic origin, irreversible epileptic damage to neural networks supporting cognitive functions, or reorganization plasticity after early focal lesions. Cognitive recovery has to be considered as a "bonus," which can be predicted in some specific circumstances.
引用
收藏
页码:1266 / 1276
页数:11
相关论文
共 27 条
[1]  
Asarnow RF, 1997, DEV MED CHILD NEUROL, V39, P430
[2]  
Bayley N., 1993, MANUAL BAYLEY SCALES
[3]   Surgical treatment of epilepsy in Sturge-Weber syndrome in children [J].
Bourgeois, Marie ;
Crimmins, Darach William ;
De Oliveira, Ricardo Santos ;
Arzimanoglou, Alexis ;
Garnett, Matthew ;
Roujeau, Thomas ;
Di Rocco, Federico ;
Sainte-Rose, Christian .
JOURNAL OF NEUROSURGERY, 2007, 106 (01) :20-28
[4]   The development of intellectual abilities in pediatric temporal lobe epilepsy [J].
Cormack, Francesca ;
Cross, J. Helen ;
Isaacs, Elizabeth ;
Harkness, William ;
Wright, Ingram ;
Vargha-Khadem, Faraneh ;
Baldeweg, Torsten .
EPILEPSIA, 2007, 48 (01) :201-204
[5]   Posterior quadrantic epilepsy surgery: Technical variants, surgical anatomy, and case series [J].
Daniel, Roy Thomas ;
Meagher-Villemure, Kathleen ;
Farmer, Jean-Pierre ;
Andermann, Frederick ;
Villemure, Jean-Guy .
EPILEPSIA, 2007, 48 (08) :1429-1437
[6]  
DEONNA T, 2005, COGNITIVE BEHAV DISO, P28
[7]   Language cortex representation: Effect of developmental versus acquired pathology [J].
Duchowny, M ;
Jayakar, P ;
Harvey, AS ;
Resnick, T ;
Alvarez, L ;
Dean, P ;
Levin, B .
ANNALS OF NEUROLOGY, 1996, 40 (01) :31-38
[8]   Aberrant neural circuits in malformations of cortical development and focal epilepsy [J].
Duchowny, M ;
Jayakar, P ;
Levin, B .
NEUROLOGY, 2000, 55 (03) :423-428
[9]   Cognitive function in preschool children after epilepsy surgery: Rationale for early intervention [J].
Freitag, H ;
Tuxhorn, I .
EPILEPSIA, 2005, 46 (04) :561-567
[10]   Abnormal development of the human cerebral cortex: genetics, functional consequences and treatment options [J].
Guerrini, Renzo ;
Dobyns, William B. ;
Barkovich, A. James .
TRENDS IN NEUROSCIENCES, 2008, 31 (03) :154-162