Impact of epilepsy surgery on the adaptive behavior of children with drug-resistant epilepsy.

OBJECTIVE

This study was undertaken to assess the impact of surgical treatment on the adaptive abilities of children with drug-resistant epilepsy (DRE) and moderate or severe developmental delays, and to identify factors that could potentially predict adaptive outcomes following epilepsy surgery.

METHODS

A retrospective observational cohort study was conducted involving 130 pediatric patients with DRE treated in the Ribeirão Preto Epilepsy Surgery Program of the University of São Paulo between 1996 and 2019. Patients underwent comprehensive preoperative evaluations, including neurological, psychiatric, social, and neuropsychological assessments using the Vineland Adaptive Behavior Scale. Adaptive functioning was assessed at three time points: before surgery and approximately 15 months and 34 months after surgery. Seizure outcomes were classified using the Engel scale. Statistical analyses included analysis of variance, Spearman correlation, and general linear model for repeated measures.

RESULTS

Before surgery, patients exhibited severe adaptive delays, with an average age equivalence (AE) of 18.2 months compared to an average chronological age of 78 months. Postoperatively, significant improvements in AE were observed, particularly among patients who achieved seizure freedom (Engel class I). At the first postoperative evaluation (median of 15 months after surgery), the average AE increased to 24.1 months (p < .01). At the second postoperative evaluation (median of 34 months after surgery), the average AE further increased to 27.5 months. Seizure-free patients demonstrated greater improvements in adaptive skills compared to those who continued to experience seizures (F = 5.845, p = .018) SIGNIFICANCE: This study reinforces that epilepsy surgery can lead to significant adaptive improvements in children with DRE, including those with severe neurological impairments. The findings highlight the positive impact of seizure freedom on developmental progress and underscore the importance of early intervention to minimize adaptive delays.