Sibilia Valentina, Barba Carmen, Metitieri Tiziana, Michelini Giovanni, Giordano Flavio, Genitori Lorenzo, Guerrini Renzo
Pediatric Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139 Florence, Italy.
Department of Neuroscience -University of Parma, Via Volturno 39, 43125, Parma, Italy.
Epilepsy Behav. 2017 Aug;73:23-30. doi: 10.1016/j.yebeh.2017.03.001. Epub 2017 Jun 9.
To analyze the determinants of cognitive outcome two years after surgery for drug-resistant epilepsy in a cohort of 31 children when compared to a control group of 14 surgical candidates who had yet to undergo surgery two years after the first neuropsychological assessment.
Controlled longitudinal study including three evaluations of IQ (Intelligence Quotient) scores or GDQ (General Developmental Quotient) for each group depending on the patient's age: prior to surgery (T0), one year (T1) and two years (T2) after surgery for the surgical group; baseline (T0) and one year (T1) and 2years (T2) after the first evaluation for the control-group. At follow-up, 25 children (80%) of the surgical group were seizure free, while seizure outcome was unsatisfactory in the remaining six (20%). To analyze language, visuomotor skills, memory, reading, visual attention, and behavior, we selected 11 school age children in the surgical group and nine controls. We reported performance prior to (T0) and one year after surgery (T1).
There was a significant correlation between earlier age at seizure onset and lower IQ/GDQ at T0 (r=0.39; p=0.03) in the overall cohort. IQ/GDQ scores did not significantly differ between the surgical and control groups when analyzed at T0 and T2. However, they evolved differently with an improved developmental trajectory becoming identifiable only in the surgical group (F=5.33 p=0.028; η=0.15). There was also a significant increase of forward digit span (Z=2.33; p=0.02) and Rey recall scores (Z=1.97; p=0.049) in the surgical school age subgroup at T1 versus T0.
We identified significantly different developmental trajectories in operated versus non- operated children with improved IQ/GDQ scores in operated children only. We also observed a significant increase of digit span scores and Rey recall scores a year after surgery. Further studies including larger samples with longer follow-ups are needed to confirm these preliminary findings.
分析31名耐药性癫痫患儿术后两年认知结果的决定因素，并与14名手术候选患儿的对照组进行比较，这些候选患儿在首次神经心理学评估两年后仍未接受手术。
进行对照纵向研究，根据患者年龄对每组进行三次智商（IQ）分数或一般发育商（GDQ）评估：手术组在手术前（T0）、术后一年（T1）和术后两年（T2）；对照组在首次评估的基线（T0）、一年（T1）和两年（T2）。随访时，手术组25名儿童（80%）无癫痫发作，其余6名（20%）癫痫发作结果不理想。为分析语言、视觉运动技能、记忆、阅读、视觉注意力和行为，我们在手术组中选择了11名学龄儿童和9名对照组儿童。我们报告了手术前（T0）和术后一年（T1）的表现。
在整个队列中，癫痫发作起始年龄较早与T0时较低的IQ/GDQ之间存在显著相关性（r=0.39；p=0.03）。在T0和T2时分析，手术组和对照组的IQ/GDQ分数没有显著差异。然而，它们的发展轨迹不同，只有手术组出现了改善的发展轨迹（F=5.33，p=0.028；η=0.15）。在学龄手术亚组中，T1时的前向数字广度（Z=2.33；p=0.02）和雷伊回忆分数（Z=1.97；p=0.049）与T0相比也有显著增加。
我们发现手术儿童与未手术儿童的发育轨迹存在显著差异，仅手术儿童的IQ/GDQ分数有所改善。我们还观察到术后一年数字广度分数和雷伊回忆分数显著增加。需要进一步的研究，包括更大样本和更长随访时间，以证实这些初步发现。
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