Temporal Lobe Resections in Children with Epilepsy: Neuropsychiatric Status in Relation to Neuropathology and Seizure Outcome

doi:10.1006/ebeh.2001.0297

Epilepsy & Behavior

Volume 3, Issue 1, February 2002, Pages 76-81

https://doi.org/10.1006/ebeh.2001.0297 Get rights and content

Abstract

The purpose of this work was to relate clinical neuropsychiatric findings to histopathological diagnoses and seizure outcome in a retrospective study of 16 children undergoing temporal lobe resections due to medically intractable epilepsy. These children constitute a heterogeneous group in which neuropsychiatric symptoms were common. The results of this study indicate a correlation between malformations of cortical development, less chance of seizure freedom, and neuropsychiatric problems in children with pharmacoresistant temporal lobe epilepsy. It is important to include neuropsychiatric assessments pre- and postoperatively and to inform parents that symptoms of autism spectrum disorders may or may not be improved after epilepsy surgery.

References (31)

CA Szabo et al.
Epilepsy surgery in children with pervasive developmental disorder
Pediatr Neurol
(1999)
DP Purpura et al.
Microtubule disarray in cortical dendrites and neurobehavioural failure. I
Golgi and electron microscopic studies. Brain Res
(1982)
J Lindsay et al.
Long-term outcome in Children with Temporal Lobe Seizures. III. Psychiatric aspects in childhood and adult life
Dev Med Child Neurol
(1979)
M Duchowny et al.
The preoperative evaluation of paediatric temporal lobe epilepsy
E Wyllie et al.
Seizure outcome after epilepsy surgery in children and adolescents
Ann Neurol
(1998)
A Mohamed et al.
Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery
Neurology
(2001)
M Lendt et al.
Behavioural disorders in children with epilepsy: Early improvements after surgery
J Neurol Neurosurg Psychiatry
(2000)
CA Szabo et al.
Neuropsychological effect of temporal lobe resection in preadolescent children with epilepsy
Epilepsia
(1998)
BT Adams et al.
Temporal lobectomy in 44 children: Outcome and neuropsychological follow-up
J Epilepsy
(1990)
J Zentner et al.
Surgical treatment of temporal lobe epilepsy: Clinical radiological, and histopathological findings in 178 patients
J Neurol Neurosurg Psychiatry
(1995)

CK Conners

A teacher rating scale for use in drug studies in children

Am J Psychiatry

(1969)

T Brown et al.

Correlates of teachers ratings, sustained attention, and impulsivity in hyperactive and normal boys

J Clin Child Psychol

(1982)

Diagnostic and statistical manual of mental disorders

(1994)

J Engel

Surgical treatment of the epilepsies

(1987)

M Bourgeois et al.

Surgery of epilepsy associated with focal lesions in childhood

J Neurosurg

(1999)

Cited by (31)

Autism Spectrum Disorder and Epilepsy
2022, Neurologic Clinics
Citation Excerpt :
However, mixed results are seen with behavioral outcomes from drastic improvement64 to not seeing any overwhelmingly positive gains.65 Larger more recent case series have also shown decreased seizure burden and the most part either no change or moderate improvement in behavior, again highlighting the importance of extensive neuropsychiatric work-up before surgery.66–68 This three and a half-year-old boy presented with a history of drug-resistant epilepsy and autism.
Surgery for Intractable Epilepsy in Pediatrics, a Systematic Review of Outcomes other than Seizure Freedom
2021, Seminars in Pediatric Neurology
To perform a systematic review evaluating reported outcomes for epilepsy surgery in pediatric patients with pharmacoresistant epilepsy beyond seizure control, including impact on quality of life, behavioral, neurocognitive outcomes as well as complications, and death. We reviewed articles from both EMBASE and MEDLINE/PubMed articles that met formal criteria (patients ≤18 years, those with intractable epilepsy, at least 5 patients in the case series, published in peer-reviewed journal). Each reviewer independently reviewed the articles and those with discrepancies were discussed and consensus was reached. Out of a total of 536 abstracts obtained from EMBASE and MEDLINE/PubMed searches combined with additional cross-referencing, a total of 98 manuscripts ultimately met all inclusion criteria. The manuscripts were divided into 3 outcomes categories: Quality of Life (16), Cognitive Outcomes (60), and Deficits and Complications (50). Several papers fell into more than 1 category. These were separated by surgical types and evaluated. We found that overall reporting in all domains was variable and inconsistent amongst the different studies. This systematic review highlights the lack of completeness in reporting outcomes and complications involving pediatric epilepsy surgery and discordant results. This underscores the importance of multicenter systematic prospective data collection in pediatric patients who undergo pediatric epilepsy surgery.
Neuropsychological outcomes following paediatric temporal lobe surgery for epilepsies: Evidence from a systematic review
2017, Seizure
The systematic review aimed to assess the neuropsychological outcomes of temporal lobe resections for epilepsy in children. Additional objectives included determining whether earlier age at surgery leads to better neuropsychological outcomes; the relationships between and predictors of these outcomes.
Using advanced search terms, a systematic review of electronic databases was conducted, comprising MEDLINE, Embase, PsycINFO, Global Health, Web of Science and CINAHL. Included studies reported on outcome following neurosurgical treatment for epilepsy. Specifically, studies were included if they reported neuropsychological outcomes and were concerned only with temporal lobe resection.
73 studies met inclusion criteria. For reported neuropsychological outcomes, the majority of participants remained stable after surgery; some declined and some improved. There was some evidence for increased material-specific memory deficits after temporal lobe surgery based on resection side, and more positive cognitive outcome for those with lower pre-surgical ability level.
Retrieved evidence highlights the need for improvements to quality of methodology and reporting. Appropriately designed prospective multicentre trials should be conducted with adequate follow-up for long-term outcomes to be measured. Core outcome measures should be agreed between centres. This would permit higher quality evidence so that clinicians, young people and their families may make better informed decisions about whether or not to proceed with surgery and likely post-operative profile.
Epilepsy Associated with ASD and Intellectual Disability
2016, Neuronal and Synaptic Dysfunction in Autism Spectrum Disorder and Intellectual Disability
The co-occurrence of autism spectrum disorder (ASD), intellectual disability (ID), and epilepsy is well established among clinicians and researchers. Epilepsy is reported to occur in ASD, with a prevalence ranging from 5% to 46%. Among patients with epilepsy, ASD symptoms may occur in 15–35% of children and about a quarter will also have ID. Epilepsy onset shows a bimodal curve with a first peak before 5 years of age and a second during adolescence. Seizures may be either focal or generalized including infantile spasms. Epileptic encephalopathies in addition to intractable seizures often manifest ID and ASD. The frequent association among epileptic, ID, and autistic phenotypes suggests that these disorders may share common predisposing genes. Molecular genetic studies and, more recently, whole-exome sequencing have indeed shown that mutations of specific genes may cause ASD, seizures, and ID, which confirms the common underlying pathophysiological mechanism at least in some patients.
Epilepsy surgery in children with accompanying impairments
2013, European Journal of Paediatric Neurology
Citation Excerpt :
It has the advantage of being prospective since 1995 and with a structured 2-year follow-up of all individuals, with only one person lost to follow-up. Part of the material has been described earlier, in one paper focussing on histopathology,11 two addressing neuropsychiatric aspects12,13 and one on low IQ and resections.14 The limitation of this study is that the numbers in each group are small and do not allow comparisons.
The aim of this study was to assess seizure outcome 2 years after epilepsy surgery in a consecutive series of paediatric patients, with special focus on children with learning disabilities and other neuroimpairments in addition to the epilepsy.
Outcome 2 years after surgery was assessed in 110 of 125 children operated upon for drug resistant epilepsy in Gothenburg 1987–2006.
More than half of the children had learning disabilities, 43% motor impairments and 30% a neuropsychiatric diagnosis. Fifty-six per cent of those with an IQ < 70 became seizure-free or had a >75% reduction in seizure frequency, and two thirds if the operation was a resection. The corresponding figure in those with more than 100 seizures per month was 15 out of 31, and another seven had a 50–75% reduction in seizure frequency.
The message is that learning disability, motor impairment and psychiatric morbidity should not be contraindications for paediatric epilepsy surgery. More than half of the children with learning disabilities had a worthwhile seizure outcome, with even better results after resective surgery. Children with drug resistant epilepsy and additional severe neurological impairments should have the benefit of referral to a tertiary centre for evaluation for epilepsy surgery.
The effects of epilepsy surgery on emotions, behavior, and psychosocial impairment in children and adolescents with drug-resistant epilepsy: A prospective study
2009, Epilepsy and Behavior
Citation Excerpt :
Overall seizure outcome from resective surgery for refractory epilepsy in childhood is favorable, with outcomes similar to those in adult studies with 50–60% of patients rendered seizure free [4–6]. The small literature to date in the child and adolescent population that examines epilepsy surgery outcomes in the broader context of emotions, behavior, and psychosocial impairment has been favorable [7–9]. However, most studies have been retrospective, and the small number of prospective studies have shown conflicting results [10,11].
This study examines change in behavioral disorders and psychosocial impairment following epilepsy surgery in 13 children and adolescents with drug-resistant epilepsy. Subjects were screened for emotional and behavioral symptoms four times pre- and postoperatively using the Strengths and Difficulties Questionnaire, and were followed for up to 8.5 years after surgery. The results of this study demonstrated significantly lower scores in emotional and behavioral symptoms after surgery. A downward trend in total difficulty scores for the group was demonstrated over the three postoperative time points. The mean Impact Score showed an initial decrease at the first follow-up time point after surgery with no further improvement subsequently. Our findings suggest that emotional and behavioral symptoms in children undergoing epilepsy surgery may improve following surgery, with reduction in their functional impact, and that these improvements are maintained in the long term.

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¹: To whom correspondence should be addressed. E-mail: [email protected]. Fax: +46 (0)31 172169.

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Original ReportsTemporal Lobe Resections in Children with Epilepsy: Neuropsychiatric Status in Relation to Neuropathology and Seizure Outcome

Abstract

Pediatr Neurol

Golgi and electron microscopic studies. Brain Res

Long-term outcome in Children with Temporal Lobe Seizures. III. Psychiatric aspects in childhood and adult life

Dev Med Child Neurol

The preoperative evaluation of paediatric temporal lobe epilepsy

Seizure outcome after epilepsy surgery in children and adolescents

Ann Neurol

Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery

Neurology

Behavioural disorders in children with epilepsy: Early improvements after surgery

J Neurol Neurosurg Psychiatry

Neuropsychological effect of temporal lobe resection in preadolescent children with epilepsy

Epilepsia

Temporal lobectomy in 44 children: Outcome and neuropsychological follow-up

J Epilepsy

Surgical treatment of temporal lobe epilepsy: Clinical radiological, and histopathological findings in 178 patients