Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.
Seizure. 2020 Apr;77:86-92. doi: 10.1016/j.seizure.2019.07.021. Epub 2019 Jul 26.
The neuropsychological outcome of pediatric epilepsy surgery has been reported before, but only few studies compared different major types of surgery in differentially located epilepsies.
Neuropsychological performance of 306 children and adolescents (ages 6-17 years) were assessed before and one year after epilepsy surgery. Individual impairments, changes into and out of impairment, as well as intraindividually meaningful positive or negative changes were examined. Regression analyses addressed the effects of site, side, pathology, type of surgery, seizure outcome, and drug change on the cognitive and behavioral domains.
Preoperatively 85% of the patients had cognitive impairments in at least one domain, 71% had behavioral problems. Postoperatively the number of impaired patients dropped considerably: 21-50% of the patients changed from impaired to unimpaired, individually significant gains were registered in 16-42%. Seizure freedom was achieved in 81% of all patients. The number of antiepileptic drugs decreased significantly. Seizure freedom, a younger age at evaluation, a later age at onset, a lower antiepileptic drug load, and less baseline damage predict better cognitive and behavioral outcomes. Gender, pathology, localization, and lateralization had little or no impact.
Differentially located and lateralized epilepsies hardly differed in cognition and behavior indicating nonspecific developmental rather than domain specific impairments. Childhood epilepsy surgery is very successful and the functional improvements one year after surgery confirm the general relevance of baseline damage, mental reserve capacities, functional plasticity, the preservation of functional tissues and the functional release due to seizure freedom and drug load reduction.
儿科癫痫手术的神经心理学结果此前已有报道，但仅有少数研究比较了不同主要类型手术在不同部位癫痫中的作用。
对 306 名儿童和青少年（6-17 岁）进行了术前和术后一年的神经心理学评估。检查了个体损伤、损伤的变化以及个体有意义的阳性或阴性变化。回归分析探讨了部位、侧别、病理、手术类型、癫痫发作结果和药物变化对认知和行为领域的影响。
术前 85%的患者在至少一个领域存在认知障碍，71%的患者存在行为问题。术后受损患者的数量明显减少：21-50%的患者从受损变为未受损，16-42%的患者有显著的个体获益。所有患者中有 81%达到无癫痫发作。抗癫痫药物的数量显著减少。无癫痫发作、评估时年龄较小、发病年龄较晚、抗癫痫药物负荷较低以及基线损伤较小，预测认知和行为结果更好。性别、病理、定位和侧别影响较小或没有影响。
不同部位和侧别的癫痫在认知和行为方面几乎没有差异，表明非特定的发育障碍而不是特定领域的损伤。儿童期癫痫手术非常成功，术后一年的功能改善证实了基线损伤、心理储备能力、功能可塑性、功能组织的保留以及由于无癫痫发作和药物负荷减少而导致的功能释放的普遍相关性。
