School of Psychology, The University of Sydney, Camperdown, NSW, 2007, Australia.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, 15238, USA.
Neuropsychologia. 2019 Oct;133:107155. doi: 10.1016/j.neuropsychologia.2019.107155. Epub 2019 Aug 6.
Early damage to the ventromedial prefrontal cortex (VM) has been associated with impaired behavioural functioning in children without epilepsy, yet behaviour in children with epilepsy and VM lesions has not been investigated. The primary aim of this study was to examine behavioural outcomes in children with epilepsy emanating from the VM preoperatively and one year after epilepsy surgery compared to the general population and matched epilepsy controls. Behavioural outcomes were defined as comprising both problems and competencies (i.e. social, school and co-curricular performance). A secondary aim was to examine whether seizure outcome, number of antiepileptic drugs (AEDs), or age at surgery related to behavioural outcomes. Ratings on the Child Behavior Checklist were examined preoperatively and 1 year after surgery for 20 children with epilepsy who had undergone surgical resection of the VM (N = 10) or temporal lobe (TL, N = 10). VM and TL groups were comparable on Full Scale IQ (40-101), age of seizure onset (0.5-9.0 years), age at surgery (3.1-16.9 years), seizure laterality (5 left in each group), age at assessments, sex (3 female in VM group, 2 female in TL group) and seizure outcome (7 seizure free in VM group, 6 seizure free in TL group). The VM group had significantly elevated behaviour problems (i.e. withdrawn, thought, social and attention problems) and reduced competencies (i.e. social and school) compared to the general population before and after surgery. VM and TL cases did not differ on any behaviour problem scales pre or postoperatively and neither group showed significant change in functioning over time; however, VM patients had significantly lower total competence than TL patients postoperatively. A significant seizure outcome × time interaction was observed: children who were seizure free following surgery (collapsed across surgical site) showed an improvement in total behaviour problems and aggression at 1 year follow-up, whereas children with ongoing seizures showed a deterioration in these domains. In conclusion, VM lesions in children with epilepsy are associated with behavioural problems but their profile does not differ from that of children with temporal lobe epilepsy. These results are consistent with the concept that seizures arise from epileptogenic networks that may affect multiple cortical areas, even when onset is in a focal site.
早期腹内侧前额叶皮层 (VM) 的损伤与无癫痫儿童的行为功能障碍有关，但尚未研究 VM 病变的癫痫儿童的行为。本研究的主要目的是检查术前和癫痫手术后一年来自 VM 的癫痫儿童的行为结果，并与普通人群和匹配的癫痫对照组进行比较。行为结果定义为包括问题和能力（即社交、学校和课外活动表现）。次要目的是检查癫痫发作结果、抗癫痫药物 (AED) 的数量或手术年龄是否与行为结果相关。对接受 VM（N=10）或颞叶（TL，N=10）手术切除的 20 名癫痫儿童的儿童行为检查表进行术前和术后 1 年的评估。VM 和 TL 组在全量表智商（40-101）、癫痫发作年龄（0.5-9.0 岁）、手术年龄（3.1-16.9 岁）、癫痫发作偏侧性（每组 5 例左）、评估年龄、性别（VM 组 3 例女性，TL 组 2 例女性）和癫痫发作结果（VM 组 7 例无癫痫发作，TL 组 6 例无癫痫发作）方面相似。与术前和术后的普通人群相比，VM 组的行为问题（即退缩、思维、社交和注意力问题）明显升高，能力（即社交和学校）降低。VM 和 TL 病例在术前和术后任何行为问题量表上均无差异，并且两个组在时间上都没有表现出明显的功能变化；然而，VM 患者术后的总能力明显低于 TL 患者。观察到显著的癫痫发作结果时间交互作用：术后无癫痫发作（合并手术部位）的儿童在 1 年随访时总行为问题和攻击性均有所改善，而持续发作的儿童在这些领域则恶化。总之，VM 病变与癫痫儿童的行为问题有关，但它们的表现与颞叶癫痫儿童的表现不同。这些结果与这样的概念一致，即癫痫发作源自可能影响多个皮质区域的致痫性网络，即使发作起源于局灶性部位。
