1
|
Eriksson MH, Prentice F, Piper RJ, Wagstyl K, Adler S, Chari A, Booth J, Moeller F, Das K, Eltze C, Cooray G, Perez Caballero A, Menzies L, McTague A, Shavel-Jessop S, Tisdall MM, Cross JH, Martin Sanfilippo P, Baldeweg T. Long-term neuropsychological trajectories in children with epilepsy: does surgery halt decline? Brain 2024; 147:2791-2802. [PMID: 38643018 PMCID: PMC11292899 DOI: 10.1093/brain/awae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 04/22/2024] Open
Abstract
Neuropsychological impairments are common in children with drug-resistant epilepsy. It has been proposed that epilepsy surgery might alleviate these impairments by providing seizure freedom; however, findings from prior studies have been inconsistent. We mapped long-term neuropsychological trajectories in children before and after undergoing epilepsy surgery, to measure the impact of disease course and surgery on functioning. We performed a retrospective cohort study of 882 children who had undergone epilepsy surgery at Great Ormond Street Hospital (1990-2018). We extracted patient information and neuropsychological functioning [obtained from IQ tests (domains: full-scale IQ, verbal IQ, performance IQ, working memory and processing speed) and tests of academic attainment (reading, spelling and numeracy)] and investigated changes in functioning using regression analyses. We identified 500 children (248 females) who had undergone epilepsy surgery [median age at surgery = 11.9 years, interquartile range = (7.8, 15.0)] and neuropsychological assessment. These children showed declines in all domains of neuropsychological functioning in the time leading up to surgery (all P-values ≤0.001; e.g. βFSIQ = -1.9, SEFSIQ = 0.3, PFSIQ < 0.001). Children lost on average one to four points per year, depending on the domain considered; 27%-43% declined by ≥10 points from their first to their last preoperative assessment. At the time of presurgical evaluation, most children (46%-60%) scored one or more standard deviations below the mean (<85) on the different neuropsychological domains; 37% of these met the threshold for intellectual disability (full-scale IQ < 70). On a group level, there was no change in performance from pre- to postoperative assessment on any of the domains (all P-values ≥0.128). However, children who became seizure free through surgery showed higher postoperative neuropsychological performance (e.g. rrb-FSIQ = 0.37, P < 0.001). These children continued to demonstrate improvements in neuropsychological functioning over the course of their long-term follow-up (e.g. βFSIQ = 0.9, SEFSIQ = 0.3, PFSIQ = 0.004). Children who had discontinued antiseizure medication treatment at 1-year follow-up showed an 8- to 13-point advantage in postoperative working memory, processing speed and numeracy, and greater improvements in verbal IQ, working memory, reading and spelling (all P-values ≤0.034) over the postoperative period compared with children who were seizure free and still receiving antiseizure medication. In conclusion, by providing seizure freedom and the opportunity for antiseizure medication cessation, epilepsy surgery might not only halt but reverse the downward trajectory that children with drug-resistant epilepsy display in neuropsychological functioning. To halt this decline as soon as possible or, potentially, to prevent it from occurring in the first place, children with focal epilepsy should be considered for epilepsy surgery as early as possible after diagnosis.
Collapse
Affiliation(s)
- Maria H Eriksson
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Freya Prentice
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Rory J Piper
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Konrad Wagstyl
- Department of Imaging Neuroscience, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Sophie Adler
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Aswin Chari
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - John Booth
- Data Research, Innovation and Virtual Environments Unit, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Friederike Moeller
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Krishna Das
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Christin Eltze
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Gerald Cooray
- Department of Neurophysiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Clinical Neuroscience, Karolinska Institutet, Solna 171 77, Sweden
| | - Ana Perez Caballero
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Lara Menzies
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Amy McTague
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Clinical Genetics, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Sara Shavel-Jessop
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Martin M Tisdall
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - J Helen Cross
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Young Epilepsy, Lingfield, RH7 6PW, UK
| | - Patricia Martin Sanfilippo
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Torsten Baldeweg
- Developmental Neurosciences Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Neuropsychology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| |
Collapse
|
2
|
Schmidlechner T, Zaddach M, Heinen F, Cornell S, Ramantani G, Rémi J, Vollmar C, Kunz M, Borggraefe I. IQ changes after pediatric epilepsy surgery: a systematic review and meta-analysis. J Neurol 2024; 271:177-187. [PMID: 37770569 PMCID: PMC10770207 DOI: 10.1007/s00415-023-12002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE This systematic review aimed to assess the intellectual outcome of children who underwent surgery for epilepsy. METHODS A systematic review of electronic databases was conducted on December 3, 2021, for PubMed and January 11, 2022, for Web of Science. The review was conducted according to the PRISMA guidelines. The included studies reported on intelligence quotient (IQ) or developmental quotient (DQ) before and after epilepsy surgery in children. Studies were included, if the patients had medically intractable epilepsy and if the study reported mainly on curative surgical procedures. We conducted a random-effects meta-analysis to determine the mean change of IQ/DQ. RESULTS Fifty-seven studies reporting on a total of 2593 patients met the inclusion criteria. The mean age at surgery was 9.2 years (± 3.44; range 2.4 months-19.81 years). Thirty-eight studies showed IQ/DQ improvement on a group level, 8 yielded stable IQ/DQ, and 19 showed deterioration. Pooled analysis revealed a significant mean gain in FSIQ of + 2.52 FSIQ points (95% CI 1.12-3.91). The pooled mean difference in DQ was + 1.47 (95% CI - 6.5 to 9.5). The pooled mean difference in IQ/DQ was 0.73 (95% CI - 4.8 to 6.2). Mean FSIQ gain was significantly higher in patients who reached seizure freedom (+ 5.58 ± 8.27) than in patients who did not (+ 0.23 ± 5.65). It was also significantly higher in patients who stopped ASM after surgery (+ 6.37 ± 3.80) than in patients who did not (+ 2.01 ± 2.41). Controlled studies showed a better outcome in the surgery group compared to the non-surgery group. There was no correlation between FSIQ change and age at surgery, epilepsy duration to surgery, and preoperative FSIQ. SIGNIFICANCE The present review indicates that there is a mean gain in FSIQ and DQ in children with medically intractable epilepsy after surgery. The mean gain of 2.52 FSIQ points reflects more likely sustainability of intellectual function rather than improvement after surgery. Seizure-free and ASM-free patients reach higher FSIQ gains. More research is needed to evaluate individual changes after specific surgery types and their effect on long-term follow-up.
Collapse
Affiliation(s)
- Tristan Schmidlechner
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Malin Zaddach
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Florian Heinen
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Sonia Cornell
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany
| | - Georgia Ramantani
- Department of Neuropediatrics, University Children's Hospital, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Jan Rémi
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Vollmar
- Department of Neurology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ingo Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Department of Pediatrics, Dr. Von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Lindwurmstreet 4, 80337, Munich, Germany.
- Comprehensive Epilepsy Center, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| |
Collapse
|
3
|
Oyegbile-Chidi T, Harvey D, Dunn D, Jones J, Byars A, Fastenau P, Austin J, Hermann B. The Impact of Sociodemographic Disadvantage on Cognitive Outcomes in Children With Newly Diagnosed Seizures and Their Unaffected Siblings Over 36 Months. Pediatr Neurol 2023; 148:178-188. [PMID: 37742443 DOI: 10.1016/j.pediatrneurol.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Accumulating evidence indicates that children with newly diagnosed epilepsy have comorbidities including cognitive challenges. Research investigating comorbidities has focused on clinical epilepsy characteristics and neurobiological/genetic correlates. The role that sociodemographic disadvantage (SD) may play has received less attention. We investigated the role of SD in cognitive status in youth with newly diagnosed epilepsy over a follow-up of 36 months to determine the degree, extent, and duration of the role of disadvantage. METHODS A total of 289 children (six to 16 years) within six weeks of their first seizure along with 167 siblings underwent comprehensive neuropsychological assessments (intelligence, language, memory, executive function, processing speed, and academic achievement) at baseline, 18 months later, and at 36 months from baseline. Baseline demographic information (race, caregivers education, household income, and parental marital status), clinical epilepsy characteristics (e.g., age of onset), and magnetic resonance imaging (MRI) and electroencephalographic (EEG) information was collected. RESULTS An SD index was computed for each family and categorized into four groups by level of disadvantage. In children and siblings, the least disadvantaged group exhibited the highest Full-Scale IQ, neuropsychological factor scores, and academic performances, whereas the most disadvantaged showed the polar opposite with the worst performances across all tests. Findings remained stable and significant over 36 months. Linear regression analyses indicated that disadvantage was a more constant and stable predictor of cognitive and academic performance over time compared with clinical epilepsy characteristics and MRI/EEG abnormalities. CONCLUSIONS This study indicates the strong association between SD and cognitive/academic performance in children with newly diagnosed epilepsy and their siblings is significant and predictive of three-year cognitive outcomes.
Collapse
Affiliation(s)
| | - Danielle Harvey
- Department of Public Health Sciences, University of California Davis, Sacramento, California
| | - David Dunn
- Departments of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anna Byars
- Department of Pediatrics, Cincinnati Children's Hospital at the University of Cincinnati, Cincinnati, Ohio
| | - Philip Fastenau
- Department of Neurology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Joan Austin
- Distinguished Professor Emerita, School of Nursing, Indiana University, Indianapolis, Indiana
| | - Bruce Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
4
|
Oyegbile-Chidi T, Harvey D, Jones J, Byars A, Austin J, Hermann B, Dunn D. Impact of sociodemographic disadvantage on neurobehavioral outcomes in children with newly diagnosed seizures and their unaffected siblings over 36 months. Epilepsia 2023; 64:2172-2185. [PMID: 37264778 PMCID: PMC10526637 DOI: 10.1111/epi.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study was undertaken to determine the short-term and longer term impact of sociodemographic disadvantage on the emotional-behavioral status of youths with new onset epilepsy and their unaffected siblings at the time of diagnosis and the subsequent 3 years. METHODS Three hundred twelve youths with newly diagnosed epilepsies and 223 unaffected siblings, aged 6-16 years, were independently assessed regarding their emotional and behavioral status by their parents and teachers at baseline, and at 18 at 36 months later; youths with seizures also completed self-report measures of depression, anxiety, and hostility at those three time points. A sociodemographic disadvantage score was computed for each family (children with newly diagnosed seizures and their siblings), and families were separated into four categories from most disadvantaged to least disadvantaged. RESULTS In both children and siblings, the least disadvantaged group exhibited the lowest level of neurobehavioral problems, whereas the most disadvantaged group showed a higher level of neurobehavioral problems across all the same behavior metrics. Findings remained stable and significant across all informants (parent, teacher, child) and across all time periods (throughout the 3-year period). Furthermore, both corrected and uncorrected linear regression analyses indicated that disadvantage was a more constant and stable predictor of behavioral and emotional problems over time compared to clinical seizure characteristics and abnormalities in magnetic resonance imaging and electroencephalographic testing. SIGNIFICANCE Sociodemographic disadvantage bears a strong relationship to youths with emotional and behavioral problems both at the time of diagnosis as well as prospectively. The relationship is robust and reflected in reports from multiple informants (parent, teacher, child self-report), evident in siblings as well, and possibly more explanatory than traditional clinical seizure variables. Future studies will be needed to determine whether this disadvantage factor is modifiable with early intervention.
Collapse
Affiliation(s)
| | - Danielle Harvey
- Public Health Sciences, University of California, Davis, Davis, California, USA
| | - Jana Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Anna Byars
- Department of Neurology, Cincinnati, Cincinnati Children's Hospital, University of Cincinnati, Ohio, USA
| | - Joan Austin
- Department of Environments for Health, Indiana University, Indianapolis, Indiana, USA
| | - Bruce Hermann
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David Dunn
- Department of Psychiatry and Neurology, Indiana University, Indianapolis, Indiana, USA
| |
Collapse
|
5
|
Vasilica AM, Winsor A, Chari A, Scott R, Baldeweg T, Tisdall M. The influence of disease course and surgery on quality of life in children with focal cortical dysplasia and long-term epilepsy-associated tumours: A systematic review and meta-analysis. Epilepsy Res 2023; 192:107132. [PMID: 37023554 DOI: 10.1016/j.eplepsyres.2023.107132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Carefully selected patients with lesional epilepsy, including focal cortical dysplasia (FCD) and long-term epilepsy-associated tumours (LEAT), can benefit from epilepsy surgery. The influence of disease course and subsequent epilepsy surgery on quality of life (QoL) and intelligence quotient (IQ) is not well understood. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting QoL or IQ measures in paediatric patients with FCD and LEAT at epilepsy onset, at establishment of drug resistance (pre-operative/non-surgically managed) and post-operatively were included. To evaluate the "effect size" and clinical significance of surgery, a meta-analysis of the data was conducted using fixed effects models for weighted mean differences, 95% confidence intervals and sensitivity analyses. RESULTS Nineteen eligible studies (911 patients) were included, 17 assessing IQ and 2 evaluating QoL. Twelve studies reported preoperative and postoperative IQ measures and five reported IQ in non-surgically managed cohorts after drug resistance was established; no papers reported IQ at epilepsy onset. No significant IQ/DQ changes were detected after surgery (pre-operative pooled mean 69.32; post-operative pooled mean 69.98; p = 0.32). Age at epilepsy surgery, type of surgery and epilepsy-related pathology did not influence the post-operative IQ. QoL was reported in 2 studies with the pooled mean estimates for pre- and post-operative QoL being 42.52 and 55.50, respectively. CONCLUSIONS The present study demonstrated no statistical change in IQ and QoL following surgery in paediatric patients with FCD and LEAT. There was no data on IQ and QoL at disease onset. Attempting to understand the impact of epilepsy, ongoing seizures and surgery on IQ and QoL will facilitate planning of future studies that aim to optimise quality of life and developmental outcomes in these children. Studies assessing children at epilepsy onset with longitudinal follow-up are required to optimise the timing of epilepsy surgery on QoL and IQ.
Collapse
Affiliation(s)
| | - Alice Winsor
- Department of Basic and Clinical Neuroscience, King's College London, London, United Kingdom
| | - Aswin Chari
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom.
| | - Rodney Scott
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Division of Neurology, Nemours Children's Hospital Delaware, Wilmington, DE, United States
| | - Torsten Baldeweg
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Martin Tisdall
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom
| |
Collapse
|
6
|
Arfaie S, Amin P, Kwan ATH, Solgi A, Sarabi A, Hakak-Zargar B, Brunette-Clément T, Pushenko D, Mir-Moghtadaei K, Mashayekhi MS, Mofatteh M, Honarvar F, Ren LY, Noiseux-Lush C, Azizi Z, Pearl PL, Baldeweg T, Weil AG, Fallah A. Long-term full-scale intelligent quotient outcomes following pediatric and childhood epilepsy surgery: A systematic review and meta-analysis. Seizure 2023; 106:58-67. [PMID: 36774775 DOI: 10.1016/j.seizure.2023.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/28/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Cognitive measures are an important primary outcome of pediatric, adolescents, and childhood epilepsy surgery. The purpose of this systematic review and meta-analysis is to assess whether there are long-term alterations (≥ 5 years) in the Full-Scale Intelligence Quotient (FSIQ) of pediatric patients undergoing epilepsy surgery. METHODS Electronic databases (EMBASE, MEDLINE, and Scopus) were searched for English articles from inception to October 2022 that examined intelligence outcomes in pediatric epilepsy surgery patients. Inclusion criteria were defined as the patient sample size of ≥ 5, average follow- up of ≥5 years, and surgeries performed on individuals ≤ 18 years old at the time of surgery. Exclusion criteria consisted of palliative surgery, animal studies, and studies not reporting surgical or FSIQ outcomes. Publication bias was assessed using a funnel plot and the Quality in Prognosis Studies (QUIPS) toolset was used for quality appraisal of the selected articles. A random-effects network meta-analysis was performed to compare FSIQ between surgical patients at baseline and follow-up and Mean Difference (MD) was used to calculate the effect size of each study. Point estimates for effects and 95% confidence intervals for moderation analysis were performed on variables putatively associated with the effect size. RESULTS 21,408 studies were screened for abstract and title. Of these, 797 fit our inclusion and exclusion criteria and proceeded to full-text screening. Overall, seven studies met our requirements and were selected. Quantitative analysis was performed on these studies (N = 330). The mean long-term difference between pre- and post- operative FSIQ scores across all studies was noted at 3.36 [95% CI: (0.14, 6.57), p = 0.04, I2 = 0%] and heterogeneity was low. CONCLUSION To our knowledge, this is the first meta-analysis to measure the long-term impacts of FSIQ in pediatric and adolescent epilepsy patients. Our overall results in this meta-analysis indicate that while most studies do not show long-term FSIQ deterioration in pediatric patients who underwent epilepsy surgery, there was an increase of 3.36 FSIQ points, however, the observed changes were not clinically significant. Moreover, at the individual patient level analysis, while most children did not show long-term FSIQ deterioration, few had significant decline. These findings indicate the importance of surgery as a viable option for pediatric patients with medically refractory epilepsy.
Collapse
Affiliation(s)
- Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, QC, Canada; Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States of America
| | - Pouya Amin
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, United States of America
| | - Angela T H Kwan
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Chemical and Physical Sciences, University of Toronto, Toronto, ON, Canada
| | - Arad Solgi
- School of Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - Ali Sarabi
- School of Computing and Augmented Intelligence, Arizona State University, Tempe, AZ, United States of America
| | | | | | - Denys Pushenko
- Department of Chemical and Physical Sciences, University of Toronto, Toronto, ON, Canada; Department of Biology, University of Toronto, Toronto, ON, Canada
| | | | | | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom.
| | - Faraz Honarvar
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Lily Yuxi Ren
- Lane Medical Library and Knowledge Management Center, Stanford Medicine, Stanford University, Palo Alto, CA, United States of America
| | | | - Zahra Azizi
- Stanford Medicine, Stanford University, Palo Alto, CA, United States of America; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, United Kingdom
| | - Phillip Lawrence Pearl
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Torsten Baldeweg
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, United Kingdom; Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, United Kingdom
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Surgery, Sainte Justine Hospital, University of Montreal, Montreal, QC, Canada
| | - Aria Fallah
- Department of Neurosurgery and Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America
| |
Collapse
|
7
|
Health Disparities in Pediatric Epilepsy: Methods and Lessons Learned. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09898-1. [PMID: 35930105 PMCID: PMC9362655 DOI: 10.1007/s10880-022-09898-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 11/09/2022]
Abstract
Epilepsy affects 1% of youth and is associated with neurocognitive and psychosocial comorbidities, increased risk of mortality, and poor health-related outcomes. Health disparities in children and youth with epilepsy (CYE) have been understudied. A Special Interest Group (SIG) within the Pediatric Epilepsy Research Consortium is conducting a scoping review to systematically assess the literature and highlight the gaps in access to clinical care and management of pediatric epilepsy. The methodology for this review is presented. In conducting a peer-reviewed assessment of the scope of health disparities in pediatric epilepsy, we learned that developing the methodology for and conducting a comprehensive scoping review with multiple contributors resulted in a time-intensive process. While there is an evidence to suggest that health disparities do exist in CYE, very few studies have focused on these disparities. Disparity results are often not included in key elements of articles, lending them to be underemphasized and underrecognized. Preliminary conclusions inform several important research considerations.
Collapse
|
8
|
Lechtholz-Zey E, Bonney PA, Cardinal T, Mendoza J, Strickland BA, Pangal DJ, Giannotta S, Durham S, Zada G. Systematic Review of Racial, Socioeconomic, and Insurance Status Disparities in the Treatment of Pediatric Neurosurgical Diseases in the United States. World Neurosurg 2021; 158:65-83. [PMID: 34718199 DOI: 10.1016/j.wneu.2021.10.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Increasing light is being shed on how race, insurance, and socioeconomic status (SES) may be related to outcomes from disease in the United States. To better understand the impact of these health care disparities in pediatric neurosurgery, we performed a systematic review of the literature. METHODS We conducted a systematic review using PRISMA guidelines and MeSH terms involving neurosurgical conditions and racial, ethnic, and SES disparities. Three independent reviewers screened articles and analyzed texts selected for full analysis. RESULTS Thirty-eight studies were included in the final analysis, of which all but 2 were retrospective database reviews. Thirty-four studies analyzed race, 22 analyzed insurance status, and 13 analyzed SES/income. Overall, nonwhite patients, patients with public insurance, and patients from lower SES were shown to have reduced access to treatment and greater rates of adverse outcomes. Nonwhite patients were more likely to present at an older age with more severe disease, less likely to undergo surgery at a high-volume surgical center, and more likely to experience postoperative morbidity and mortality. Underinsured and publicly insured patients were more likely to experience delay in surgical referral, less likely to undergo surgical treatment, and more likely to experience inpatient mortality. CONCLUSIONS Health care disparities are present within multiple populations of patients receiving pediatric neurosurgical care. This review highlights the need for continued investigation into identifying and addressing health care disparities in pediatric neurosurgery patients.
Collapse
Affiliation(s)
- Elizabeth Lechtholz-Zey
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Phillip A Bonney
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Tyler Cardinal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
| | - Jesse Mendoza
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Dhiraj J Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Steven Giannotta
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Susan Durham
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA; Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| |
Collapse
|
9
|
Jehi L, Braun K. Does etiology really matter for epilepsy surgery outcome? Brain Pathol 2021; 31:e12965. [PMID: 34196987 PMCID: PMC8412085 DOI: 10.1111/bpa.12965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 12/17/2022] Open
Abstract
Multiple factors influence the outcomes of epilepsy surgery. Prognostic indicators varying from clinical characteristics, imaging findings, ictal, and interictal electrophysiological activity have been linked to surgical outcomes. In this review, we focus on the relatively under‐studied role of the underlying epilepsy histopathology in driving post‐surgical outcomes, specifically focusing on the broad categories of seizure outcomes and cognitive outcomes. For each of these two outcomes of interest, we answer two questions: 1)‐ does etiology matter? and 2)‐ how could it matter? The goal is to review the existing literature on the relationship between etiology and surgical outcomes to provide the best possible judgment as to whether a causal relationship exists between histopathology and the ultimate surgical outcome as an initial step. Then, we delve into the possible mechanisms via which such relationships can be explained. We conclude with a call to action to the epilepsy surgery and histopathology research community to push the mechanistic understanding of the pathology‐outcome interaction and identify actionable knowledge and biomarkers that could inform patient care in a timely fashion. In this review, we focus on the relatively under‐studied role of the underlying epilepsy histopathology in driving post‐surgical outcomes, specifically focusing on the broad categories of seizure outcomes and cognitive outcomes. For each of these two outcomes of interest, we answer two questions: (1) does etiology matter? and (2) how could it matter? We then delve into the mechanisms of these answers.
Collapse
Affiliation(s)
- Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, OH, USA
| | - Kees Braun
- Dept. of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands
| |
Collapse
|
10
|
Helmstaedter C, Beeres K, Elger C, Kuczaty S, Schramm J, Hoppe C. Cognitive outcome of pediatric epilepsy surgery across ages and different types of surgeries: A monocentric 1-year follow-up study in 306 patients of school age. Seizure 2020; 77:86-92. [DOI: 10.1016/j.seizure.2019.07.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/05/2019] [Accepted: 07/25/2019] [Indexed: 01/20/2023] Open
|
11
|
Benova B, Belohlavkova A, Jezdik P, Jahodová A, Kudr M, Komarek V, Novak V, Liby P, Lesko R, Tichý M, Kyncl M, Zamecnik J, Krsek P, Maulisova A. Cognitive performance in distinct groups of children undergoing epilepsy surgery-a single-centre experience. PeerJ 2019; 7:e7790. [PMID: 31608172 PMCID: PMC6788437 DOI: 10.7717/peerj.7790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/29/2019] [Indexed: 11/27/2022] Open
Abstract
Background We aimed first to describe trends in cognitive performance over time in a large patient cohort (n = 203) from a single tertiary centre for paediatric epilepsy surgery over the period of 16 years divided in two (developing—pre-2011 vs. established—post-2011). Secondly, we tried to identify subgroups of epilepsy surgery candidates with distinctive epilepsy-related characteristics that associate with their pre- and post-surgical cognitive performance. Thirdly, we analysed variables affecting pre-surgical and post-surgical IQ/DQ and their change (post- vs. pre-surgical). Methods We analysed IQ/DQ data obtained using standardized neuropsychological tests before epilepsy surgery and one year post-surgically, along with details of patient’s epilepsy, epilepsy surgery and outcomes in terms of freedom from seizures. Using regression analysis, we described the trend in post-operative IQ/DQ. Cognitive outcomes and the associated epilepsy- and epilepsy surgery-related variables were compared between periods before and after 2011. Using multivariate analysis we analysed the effect of individual variables on pre- and post-operative IQ/DQ and its change. Results Epilepsy surgery tends to improve post-surgical IQ/DQ, most significantly in patients with lower pre-surgical IQ/DQ, and post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ (Rho = 0.888, p < 0.001). We found no significant difference in pre-, post-surgical IQ/DQ and IQ/DQ change between the periods of pre-2011 and post-2011 (p = 0.7, p = 0.469, p = 0.796, respectively). Patients with temporal or extratemporal epilepsy differed in their pre-surgical IQ/DQ (p = 0.001) and in IQ/DQ change (p = 0.002) from those with hemispheric epilepsy, with no significant difference in post-surgical IQ/DQ (p = 0.888). Groups of patients with different underlying histopathology showed significantly different pre- and post-surgical IQ/DQ (p < 0.001 and p < 0.001 respectively) but not IQ/DQ change (p = 0.345).Variables associated with severe epilepsy showed effect on cognitive performance in multivariate model. Discussion Post-surgical IQ/DQ strongly correlates with pre-surgical IQ/DQ and greatest IQ/DQ gain occurs in patients with lower pre-surgical IQ/DQ scores. Cognitive performance was not affected by changes in paediatric epilepsy surgery practice. Pre- and post-operative cognitive performances, as well as patients’ potential for cognitive recovery, are highly dependent on the underlying aetiology and epileptic syndrome.
Collapse
Affiliation(s)
- Barbora Benova
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Anezka Belohlavkova
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Petr Jezdik
- Faculty of Electrical Engineering, Department of Circuit Theory, Czech Technical University of Prague, Prague, Czech Republic
| | - Alena Jahodová
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Martin Kudr
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Vladimir Komarek
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Vilem Novak
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Ostrava Faculty Hospital, Ostrava, Czech Republic
| | - Petr Liby
- Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Robert Lesko
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Michal Tichý
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Neurosurgery, Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Radiology, Motol Universiy Hospital, Prague, Czech Republic
| | - Josef Zamecnik
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Pathology and Molecular Medicine, Motol University Hospital, Prague, Czech Republic
| | - Pavel Krsek
- 2nd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Paediatric Neurology, Motol University Hospital, Prague, Czech Republic
| | - Alice Maulisova
- Department of Clinical Psychology, Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
12
|
Almanza-Sepulveda ML, Smith ML, Widjaja E. Influence of patient, caregiver, and family factors on unmet healthcare needs in children with drug-resistant epilepsy undergoing epilepsy surgery evaluation. Epilepsy Behav 2019; 99:106502. [PMID: 31493734 DOI: 10.1016/j.yebeh.2019.106502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/03/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether patient, caregiver, and family factors correlate with unmet healthcare needs in children with drug-resistant epilepsy (DRE) who were evaluated for epilepsy surgery. METHODS Caregivers of children with DRE completed questions on unmet healthcare needs, including physical and mental needs. Patient (demographic, seizure severity, and comorbidities), caregiver (sociodemographics, depression, and anxiety), and family (family functioning, resources, and demands) factors were evaluated. A series of bivariable regression was conducted to assess the associations with unmet needs (overall, physical, and mental needs), followed by multivariable regression. RESULTS Of the 86 children with DRE, 32 (37.2%) reported having overall unmet healthcare needs, 21 (24.4%) have unmet physical, and 13 (15.1%) have unmet mental healthcare needs. Multivariable regression showed that the odds of overall unmet needs in children were higher in patients with higher depressive symptoms (odds ratio [OR] = 1.7, p = 0.03), and caregivers who were unemployed (OR = 3.8, p = 0.008). The odds of unmet physical needs in children were higher among patients with higher depressive symptoms (OR = 2.0, p = 0.02), caregivers who were older (OR = 1.1, p = 0.02), and caregivers who were unemployed (OR = 6.5, p = 0.008). There were no significant correlates between patient, caregiver, and family factors with unmet mental needs (all p > 0.05). INTERPRETATION Children with DRE were at risk for not receiving needed healthcare. Patient factors such as patient depressive symptoms, and caregiver factors such as caregivers' age and employment status were associated with unmet needs. Identifying the predictors of unmet healthcare needs is a necessary step in addressing unmet needs in this population with DRE.
Collapse
Affiliation(s)
| | - Mary Lou Smith
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto Mississauga, Toronto, Canada
| | - Elysa Widjaja
- Program in Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada; Department of Diagnostic Imaging, University of Toronto, Toronto, Canada; Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.
| |
Collapse
|
13
|
Veersema TJ, van Schooneveld MMJ, Ferrier CH, van Eijsden P, Gosselaar PH, van Rijen PC, Spliet WGM, Mühlebner A, Aronica E, Braun KPJ. Cognitive functioning after epilepsy surgery in children with mild malformation of cortical development and focal cortical dysplasia. Epilepsy Behav 2019; 94:209-215. [PMID: 30974349 DOI: 10.1016/j.yebeh.2019.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/30/2022]
Abstract
Mild malformation of cortical development (mMCD) and focal cortical dysplasia (FCD) subtypes combined are by far the most common histological diagnoses in children who undergo surgery as treatment for refractory epilepsy. In patients with refractory epilepsy, a substantial burden of disease is due to cognitive impairment. We studied intelligence quotient (IQ) or developmental quotient (DQ) values and their change after epilepsy surgery in a consecutive series of 42 children (median age at surgery: 4.5, range: 0-17.0 years) with refractory epilepsy due to mMCD/FCD. Cognitive impairment, defined as IQ/DQ below 70, was present in 51% prior to surgery. Cognitive impairment was associated with earlier onset of epilepsy, longer epilepsy duration, and FCD type I histology. Clinically relevant improvement of ≥10 IQ/DQ points was found in 24% of children and was related to the presence of presurgical epileptic encephalopathy (EE). At time of postsurgical cognitive testing, 59% of children were completely seizure-free (Engel 1A). We found no association between cognitive outcome and seizure or medication status at two years of follow-up. Epilepsy surgery in children with mMCD or FCD not only is likely to result in complete and continuous seizure freedom, but also improves cognitive function in many.
Collapse
Affiliation(s)
- Tim J Veersema
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter C van Rijen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Angelika Mühlebner
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eleonora Aronica
- Department of (Neuro) Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), the Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| |
Collapse
|