Gleissner Ulrike, Clusmann Hans, Sassen Robert, Elger Christian E, Helmstaedter Christoph
Department of Epileptology, University of Bonn, Sigmund-Freud Strasse 25, 53105 Bonn, Germany.
Epilepsia. 2006 Feb;47(2):406-14. doi: 10.1111/j.1528-1167.2006.00436.x.
Intellectual disabilities are often associated with bilateral or diffuse morphologic brain damage. The chances of becoming seizure free after focal surgery are therefore considered to be worse in patients with intellectual disabilities. The risk of postoperative cognitive deficits could increase because diffuse brain damage lowers the patient's ability to compensate for surgically induced deficits. Several studies in adult patients have indicated that IQ alone is not a good predictor of postoperative cognitive and seizure outcome. Our study evaluated this subject in children and adolescents.
Pediatric patients with intellectual disabilities (IQ < or = 70), subaverage intelligence (IQ between 71 and 85), or average-range intelligence (IQ > 85) were matched according to several clinical and etiologic criteria to determine the influence of IQ (N = 66).
No dependency of seizure outcome, postoperative cognitive development, and behavioral outcome on the IQ level was found. All groups slightly improved in attention while memory functions tended to decrease and executive functions were stable. School placement remained unchanged for the majority of patients. Between 67 and 78% were seizure free 1 year after surgery (Engel outcome class I).
IQ alone is not a good predictor of postoperative outcome in pediatric patients with epilepsy. As with patients of average-range intelligence, the decision to operate on patients with a low level of intelligence should depend on the results of the presurgical diagnostics. If the results of the neuropsychological examination indicate diffuse functional impairment, this should not hinder further steps, if all other findings are consistent.
智力障碍常与双侧或弥漫性脑形态学损伤相关。因此，对于智力障碍患者，局灶性手术后无癫痫发作的几率被认为更低。由于弥漫性脑损伤会降低患者补偿手术引起的缺陷的能力，术后认知缺陷的风险可能会增加。多项针对成年患者的研究表明，仅智商并不是术后认知和癫痫发作结果的良好预测指标。我们的研究在儿童和青少年中评估了这一问题。
根据多项临床和病因学标准，对患有智力障碍（智商≤70）、智力低于平均水平（智商在71至85之间）或智力处于平均范围（智商>85）的儿科患者进行匹配，以确定智商的影响（N = 66）。
未发现癫痫发作结果、术后认知发展和行为结果对智商水平有依赖性。所有组在注意力方面均略有改善，而记忆功能趋于下降，执行功能保持稳定。大多数患者的学校安置情况保持不变。术后1年，67%至78%的患者无癫痫发作（恩格尔结果分级I级）。
仅智商并不是小儿癫痫患者术后结果的良好预测指标。与智力处于平均范围的患者一样，对智力水平低的患者进行手术的决定应取决于术前诊断的结果。如果神经心理学检查结果表明存在弥漫性功能损害，而所有其他检查结果一致，则这不应该妨碍进一步的治疗步骤。
