Ramantani Georgia, Reuner Gitta
Division of Child Neurology, University Children's Hospital, Zurich, Switzerland.
Swiss Epilepsy Centre, Zurich, Switzerland.
Neuropediatrics. 2018 Apr;49(2):93-103. doi: 10.1055/s-0037-1609034. Epub 2017 Dec 5.
Epilepsy surgery is a very effective treatment option for children and adolescents with drug-resistant structural epilepsy, resulting in seizure freedom in the majority of cases. Beyond seizure freedom, the postsurgical stabilization or even improvement of cognitive development constitutes a fundamental objective. This study aims to address key features of cognitive development in the context of pediatric epilepsy surgery. Many surgical candidates present with severe developmental delay and cognitive deficits prior to surgery. Recent studies support that global cognitive development remains stable after surgery. Individual developmental trajectories are determined by the degree of presurgical developmental impairment, age at surgery, seizure freedom, antiepileptic drug tapering, and other case-specific factors. Compared with adults, children may better compensate for temporary postsurgical deficits in circumscribed cognitive functions such as memory. Particularly for left-sided temporal resections, children present a clear advantage in terms of postsurgical recovery with regard to verbal learning compared with adults. In the case of severe presurgical developmental impairment, minimal postsurgical improvements are often not measurable, although they are evident to patients' families and have a large impact on their quality of life. Multicenter studies with a standardized assessment protocol and longer follow-up intervals are urgently called for to provide deeper insights into the cognitive development after epilepsy surgery, to analyze the interaction between different predictors, and to facilitate the selection of appropriate candidates as well as the counseling of families.
癫痫手术对于患有耐药性结构性癫痫的儿童和青少年来说是一种非常有效的治疗选择，在大多数情况下可实现无癫痫发作。除了实现无癫痫发作外，术后认知发展的稳定甚至改善也是一个基本目标。本研究旨在探讨小儿癫痫手术背景下认知发展的关键特征。许多手术候选者在手术前存在严重的发育迟缓及认知缺陷。近期研究表明，术后整体认知发展保持稳定。个体发育轨迹由术前发育损害程度、手术年龄、无癫痫发作情况、抗癫痫药物减量以及其他特定病例因素决定。与成人相比，儿童可能更能补偿术后在诸如记忆等特定认知功能方面的暂时缺陷。特别是对于左侧颞叶切除术，与成人相比，儿童在术后言语学习恢复方面具有明显优势。在术前存在严重发育损害的情况下，尽管术后的微小改善对患者家庭而言很明显且对其生活质量有很大影响，但往往无法测量。迫切需要开展具有标准化评估方案和更长随访期的多中心研究，以便更深入地了解癫痫手术后的认知发展，分析不同预测因素之间的相互作用，并促进合适候选者的选择以及为家庭提供咨询服务。
