Developmental Neurosciences Programme, Great Ormond Street Institute of Child Health, University College London, London, UK.
Department of Neuropsychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Epilepsia. 2019 May;60(5):872-884. doi: 10.1111/epi.14707. Epub 2019 Apr 10.
Intelligence quotient (IQ) outcomes after pediatric epilepsy surgery show significant individual variation. Clinical factors such as seizure cessation or antiepileptic medication discontinuation have been implicated, but do not fully account for the heterogeneity seen. Less is known about the impact of neurobiological factors, such as brain development and resection location. This study examines clinical and neuroimaging factors associated with cognitive outcome after epilepsy surgery in childhood.
Fifty-two children (28 boys, 24 girls) were evaluated for epilepsy surgery and reassessed on average 7.7 years later. In the intervening time, 13 were treated pharmacologically and 39 underwent focal surgery (17 temporal, 16 extratemporal, six multilobar; mean age at surgery = 14.0 years). Pre- and postsurgical assessments included IQ tests and T1-weighted brain images. Predictors of IQ change were investigated, including voxel-based analyses of resection location, and gray and white matter volume change.
Overall modest IQ improvement was seen in children treated surgically, but not in those treated pharmacologically only. Applying a ≥10-point change threshold, 39% of the surgically treated children improved, whereas 10% declined. Clinical factors associated with IQ increases were lower preoperative IQ and longer follow-up duration, whereas seizure and antiepileptic medication cessation were not predictive. Among neuroimaging factors, we observed that left anterior temporal resections impacted negatively on verbal reasoning, linked to full-scale IQ decline. In contrast, gray matter volume change in ipsi- and contralesional hemispheres was positively correlated with IQ change. Voxel-based morphometry identified the gray matter volume change in the contralesional dorsolateral frontal cortex as most strongly associated with IQ improvement.
We show that a variety of factors are likely to contribute to patterns of postsurgical change in IQ. Neuroimaging results indicate that left anterior temporal resections constrain development of verbal cognition, whereas simultaneously cortical growth after surgical treatment can support improvements in IQ.
儿童癫痫手术后的智商（IQ）结果显示出显著的个体差异。已涉及到临床因素，如癫痫发作停止或抗癫痫药物停药，但不能完全解释所看到的异质性。关于神经生物学因素（如大脑发育和切除部位）对认知结果的影响知之甚少。本研究检查了与儿童癫痫手术后认知结果相关的临床和神经影像学因素。
对 52 名儿童（28 名男孩，24 名女孩）进行了癫痫手术评估，并在平均 7.7 年后进行了重新评估。在此期间，13 名儿童接受药物治疗，39 名儿童接受了局灶性手术（17 例颞叶，16 例外周叶，6 例多叶；手术平均年龄= 14.0 岁）。术前和术后评估包括 IQ 测试和 T1 加权脑图像。研究了 IQ 变化的预测因素，包括切除部位的基于体素分析以及灰质和白质体积变化。
接受手术治疗的儿童总体上 IQ 有适度提高，但仅接受药物治疗的儿童则没有。应用≥10 分的变化阈值，39%的手术治疗儿童得到改善，而 10%的儿童则下降。与 IQ 增加相关的临床因素是术前 IQ 较低和随访时间较长，而癫痫发作和抗癫痫药物停药没有预测作用。在神经影像学因素中，我们观察到左侧前颞叶切除术对言语推理有负面影响，与全量表 IQ 下降有关。相比之下，对侧半球同侧和对侧半球的灰质体积变化与 IQ 变化呈正相关。基于体素的形态计量学确定了对侧背外侧额皮质的灰质体积变化与 IQ 改善最密切相关。
我们表明，多种因素可能导致 IQ 术后变化模式。神经影像学结果表明，左侧前颞叶切除术限制了言语认知的发展，而手术治疗后的皮质生长则可以支持 IQ 的提高。
