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Woodfield J, Braun KPJ, van Schooneveld MMJ, Bastin ME, Chin RFM. Efficient organisation of the contralateral hemisphere connectome is associated with improvement in intelligence quotient after paediatric epilepsy surgery. Epilepsy Behav 2023; 149:109521. [PMID: 37944287 DOI: 10.1016/j.yebeh.2023.109521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Aims of epilepsy surgery in childhood include optimising seizure control and facilitating cognitive development. Predicting which children will improve cognitively is challenging. We investigated the association of the pre-operative structural connectome of the contralateral non-operated hemisphere with improvement in intelligence quotient (IQ) post-operatively. METHODS Consecutive children who had undergone unilateral resective procedures for epilepsy at a single centre were retrospectively identified. We included those with pre-operative volume T1-weighted non-contrast brain magnetic resonance imaging (MRI), no visible contralateral MRI abnormalities, and both pre-operative and two years post-operative IQ assessment. The MRI of the hemisphere contralateral to the side of resection was anatomically parcellated into 34 cortical regions and the covariance of cortical thickness between regions was used to create binary and weighted group connectomes. RESULTS Eleven patients with a post-operative IQ increase of at least 10 points at two years were compared with twenty-four patients with no change in IQ score. Children who gained at least 10 IQ points post-operatively had a more efficiently structured contralateral hemisphere connectome with higher global efficiency (0.74) compared to those whose IQ did not change at two years (0.58, p = 0.014). This was consistent across thresholds and both binary and weighted networks. There were no statistically significant group differences in age, sex, age at onset of epilepsy, pre-operative IQ, mean cortical thickness, side or site of procedure, two year post-operative Engel scores or use of anti-seizure medications between the two groups. CONCLUSIONS Surgical procedures to reduce or stop seizures may allow children with an efficiently structured contralateral hemisphere to achieve their cognitive potential.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
| | - Kees P J Braun
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, the Netherlands; Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Monique M J van Schooneveld
- Department of Paediatric Psychology, Sector of Neuropsychology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard F M Chin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
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Woodfield J, Chin RFM, van Schooneveld MMJ, van den Heuvel M, Bastin ME, Braun KPJ. The association of structural connectome efficiency with cognition in children with epilepsy. Epilepsy Behav 2023; 148:109462. [PMID: 37844437 DOI: 10.1016/j.yebeh.2023.109462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Cognitive impairment is common in children with epilepsy (CWE), but understanding the underlying pathological processes is challenging. We aimed to investigate the association of structural brain network organisation with cognition. METHODS This was a retrospective cohort study of CWE without structural brain abnormalities, comparing whole brain network characteristics between those with cognitive impairment and those with intact cognition. We created structural whole-brain connectomes from anatomical and diffusion tensor magnetic resonance imaging using the number of streamlines and tract-averaged fractional anisotropy. We assessed the differences in average path length and global network efficiency between children with cognitive impairment and those without,using multivariable analyses to account for possible clinical group differences. RESULTS Twenty-eight CWE and cognitive impairment had lower whole brain network global efficiency compared with 34 children with intact cognition (0.54, standard deviation (SD):0.003 vs. 0.56, SD:0.002, p < 0.001), which is equivalent to longer normalized network average path lengths (1.14, SD:0.05 vs. 1.10, SD:0.02, p = 0.003). In multivariable logistic regression cognitive impairment was not significantly associated with age of onset, duration of epilepsy, or number of antiseizure medications, but was independently associated with daily seizures (p = 0.04) and normalized average path length (p = 0.007). CONCLUSIONS Higher structural network average path length and lower global network efficiency may be imaging biomarkers of cognitive impairment in epilepsy. Understanding what leads to changes in structural connectivity could aid identification of modifiable risk factors for cognitive impairment. These findings are only applicable to the specific cohort studied, and further confirmation in other cohorts is required.
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Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
| | - Richard F M Chin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom; Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom; Royal Hospital for Children and Young People, NHS Lothian, Edinburgh, United Kingdom
| | | | - Martijn van den Heuvel
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Kees P J Braun
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
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Zweiphenning W, Klooster MAV', van Klink NEC, Leijten FSS, Ferrier CH, Gebbink T, Huiskamp G, van Zandvoort MJE, van Schooneveld MMJ, Bourez M, Goemans S, Straumann S, van Rijen PC, Gosselaar PH, van Eijsden P, Otte WM, van Diessen E, Braun KPJ, Zijlmans M. Intraoperative electrocorticography using high-frequency oscillations or spikes to tailor epilepsy surgery in the Netherlands (the HFO trial): a randomised, single-blind, adaptive non-inferiority trial. Lancet Neurol 2022; 21:982-993. [PMID: 36270309 PMCID: PMC9579052 DOI: 10.1016/s1474-4422(22)00311-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Background Intraoperative electrocorticography is used to tailor epilepsy surgery by analysing interictal spikes or spike patterns that can delineate epileptogenic tissue. High-frequency oscillations (HFOs) on intraoperative electrocorticography have been proposed as a new biomarker of epileptogenic tissue, with higher specificity than spikes. We prospectively tested the non-inferiority of HFO-guided tailoring of epilepsy surgery to spike-guided tailoring on seizure freedom at 1 year. Methods The HFO trial was a randomised, single-blind, adaptive non-inferiority trial at an epilepsy surgery centre (UMC Utrecht) in the Netherlands. We recruited children and adults (no age limits) who had been referred for intraoperative electrocorticography-tailored epilepsy surgery. Participants were randomly allocated (1:1) to either HFO-guided or spike-guided tailoring, using an online randomisation scheme with permuted blocks generated by an independent data manager, stratified by epilepsy type. Treatment allocation was masked to participants and clinicians who documented seizure outcome, but not to the study team or neurosurgeon. Ictiform spike patterns were always considered in surgical decision making. The primary endpoint was seizure outcome after 1 year (dichotomised as seizure freedom [defined as Engel 1A–B] vs seizure recurrence [Engel 1C–4]). We predefined a non-inferiority margin of 10% risk difference. Analysis was by intention to treat, with prespecified subgroup analyses by epilepsy type and for confounders. This completed trial is registered with the Dutch Trial Register, Toetsingonline ABR.NL44527.041.13, and ClinicalTrials.gov, NCT02207673. Findings Between Oct 10, 2014, and Jan 31, 2020, 78 individuals were enrolled to the study and randomly assigned (39 to HFO-guided tailoring and 39 to spike-guided tailoring). There was no loss to follow-up. Seizure freedom at 1 year occurred in 26 (67%) of 39 participants in the HFO-guided group and 35 (90%) of 39 in the spike-guided group (risk difference –23·5%, 90% CI –39·1 to –7·9; for the 48 patients with temporal lobe epilepsy, the risk difference was –25·5%, –45·1 to –6·0, and for the 30 patients with extratemporal lobe epilepsy it was –20·3%, –46·0 to 5·4). Pathology associated with poor prognosis was identified as a confounding factor, with an adjusted risk difference of –7·9% (90% CI –20·7 to 4·9; adjusted risk difference –12·5%, –31·0 to 5·9, for temporal lobe epilepsy and 5·8%, –7·7 to 19·5, for extratemporal lobe epilepsy). We recorded eight serious adverse events (five in the HFO-guided group and three in the spike-guided group) requiring hospitalisation. No patients died. Interpretation HFO-guided tailoring of epilepsy surgery was not non-inferior to spike-guided tailoring on intraoperative electrocorticography. After adjustment for confounders, HFOs show non-inferiority in extratemporal lobe epilepsy. This trial challenges the clinical value of HFOs as an epilepsy biomarker, especially in temporal lobe epilepsy. Further research is needed to establish whether HFO-guided intraoperative electrocorticography holds promise in extratemporal lobe epilepsy. Funding UMCU Alexandre Suerman, EpilepsieNL, RMI Talent Fellowship, European Research Council, and MING Fund.
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Affiliation(s)
- Willemiek Zweiphenning
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Maryse A van 't Klooster
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Nicole E C van Klink
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Frans S S Leijten
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Cyrille H Ferrier
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Tineke Gebbink
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Geertjan Huiskamp
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Martine J E van Zandvoort
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Monique M J van Schooneveld
- Department of Pediatric Psychology, Wilhelmina's Children Hospital, University Medical Center Utrecht, Netherlands
| | - M Bourez
- Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands
| | - Sophie Goemans
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Sven Straumann
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Peter C van Rijen
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Peter H Gosselaar
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Pieter van Eijsden
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Willem M Otte
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Eric van Diessen
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Kees P J Braun
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands
| | - Maeike Zijlmans
- Department of Neurology and Neurosurgery, Utrecht Brain Center, University Medical Center Utrecht (Part of ERN EpiCARE), Utrecht, Netherlands; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands.
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Annink KV, de Vries LS, Groenendaal F, Eijsermans RMJC, Mocking M, van Schooneveld MMJ, Dudink J, van Straaten HLM, Benders MJNL, Lequin M, van der Aa NE. Mammillary body atrophy and other MRI correlates of school-age outcome following neonatal hypoxic-ischemic encephalopathy. Sci Rep 2021; 11:5017. [PMID: 33658541 PMCID: PMC7930036 DOI: 10.1038/s41598-021-83982-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
The mammillary bodies (MB) and hippocampi are important for memory function and are often affected following neonatal hypoxic ischemic encephalopathy (HIE). The aim of this study was to assess neurodevelopmental outcome in 10-year-old children with HIE with and without therapeutic hypothermia. Additional aims were to assess the associations between MB atrophy, brain volumes (including the hippocampi), white matter microstructure and neurodevelopmental outcome at school-age. Ten-year-old children with HIE were included, who were treated with therapeutic hypothermia (n = 22) or would have qualified but were born before this became standard of care (n = 28). Children completed a neuropsychological and motor assessment and MRI. Mammillary bodies were scored as normal or atrophic at 10 years. Brain volumes were segmented on childhood MRI and DTI scans were analysed using tract-based spatial statistics. Children with HIE suffered from neurocognitive and memory problems at school-age, irrespective of hypothermia. Hippocampal volumes and MB atrophy were associated with total and performance IQ, processing speed and episodic memory in both groups. Normal MB and larger hippocampi were positively associated with global fractional anisotropy. In conclusion, injury to the MB and hippocampi was associated with neurocognition and memory at school-age in HIE and might be an early biomarker for neurocognitive and memory problems.
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Affiliation(s)
- Kim V Annink
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | - Linda S de Vries
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | | | - Manouk Mocking
- Department of Paediatric Psychology and Social Work, UMC Utrecht, Utrecht, The Netherlands
| | | | - Jeroen Dudink
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | | | - Manon J N L Benders
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands
| | - Maarten Lequin
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, UMC Utrecht Brain Centre, Wilhelmina Children's Hospital, University Utrecht, Internal Room Number KE04.123.1, Lundlaan 6, 3508AB, Utrecht, The Netherlands.
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Sun D, van 't Klooster MA, van Schooneveld MMJ, Zweiphenning WJEM, van Klink NEC, Ferrier CH, Gosselaar PH, Braun KPJ, Zijlmans M. High frequency oscillations relate to cognitive improvement after epilepsy surgery in children. Clin Neurophysiol 2020; 131:1134-1141. [PMID: 32222614 DOI: 10.1016/j.clinph.2020.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/19/2019] [Accepted: 01/12/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate how high frequency oscillations (HFOs; ripples 80-250 Hz, fast ripples (FRs) 250-500 Hz) and spikes in intra-operative electrocorticography (ioECoG) relate to cognitive outcome after epilepsy surgery in children. METHODS We retrospectively included 20 children who were seizure free after epilepsy surgery using ioECoG and determined their intelligence quotients (IQ) pre- and two years postoperatively. We analyzed whether the number of HFOs and spikes in pre- and postresection ioECoGs, and their change in the non-resected areas relate to cognitive improvement (with ≥ 5 IQ points increase considered to be clinically relevant (=IQ+ group) and < 5 IQ points as irrelevant (=IQ- group)). RESULTS The IQ+ group showed significantly more FRs in the resected tissue (p = 0.01) and less FRs in the postresection ioECoG (p = 0.045) compared to the IQ- group. Postresection decrease of ripples on spikes was correlated with postoperative cognitive improvement (correlation coefficient = -0.62 with p = 0.01). CONCLUSIONS Postoperative cognitive improvement was related to reduction of pathological HFOs signified by removing FR generating areas with subsequently less residual FRs, and decrease of ripples on spikes in the resection edge of the non-resected area. SIGNIFICANCE HFOs recorded in ioECoG could play a role as biomarkers in the prediction and understanding of cognitive outcome after epilepsy surgery.
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Affiliation(s)
- Dongqing Sun
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Maryse A van 't Klooster
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Monique M J van Schooneveld
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Department of Pediatric Psychology, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
| | - Willemiek J E M Zweiphenning
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Nicole E C van Klink
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Cyrille H Ferrier
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Peter H Gosselaar
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Kees P J Braun
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Child Neurology, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Maeike Zijlmans
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Department of Neurology and Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Stichting Epilepsie Instellingen Nederland, Achterweg 2, 2103 SW Heemstede, the Netherlands.
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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: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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van Schooneveld MMJ, Braun KPJ, van Rijen PC, van Nieuwenhuizen O, Jennekens-Schinkel A. The spectrum of long-term cognitive and functional outcome after hemispherectomy in childhood. Eur J Paediatr Neurol 2016; 20:376-84. [PMID: 26897542 DOI: 10.1016/j.ejpn.2016.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/23/2015] [Accepted: 01/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate cognition, behavior, daily functioning and health-related quality of life (HrQoL) five years to more than a decade after hemispherectomy (HE) in childhood. METHODS This countrywide Dutch cohort study of 31 patients, who underwent HE between 1994 and 2009, included a semi-structured interview with parents, an assessment of cognition, and screening of behavioral problems and HrQoL. RESULTS Twenty-two school-age children and young adults [median age 13.8 years (0.5 at epilepsy onset, 5.3 at HE)] were assessed with age-appropriate cognitive tests. IQ ranged from 45 to 82 (median 61). Despite performing below mean norm scores, these participants could learn and remember, sustain attention, inhibit irrelevant responses, read and write. Nine more children [median age 9.7 years (0.25 at epilepsy onset, 1.4 at HE)] were so mentally retarded that age-appropriate testing was impossible. This group was almost totally dependent on others in daily activities, had the highest proportion of pre-existing contralateral MRI-abnormalities and after HE the highest rates of seizure recurrence and behavioral problems. Parents in both groups rated HrQoL surprisingly positively (mean VAS-score 72.5), with a scarce low rating (40). All parents reported problems with respect to their children's self-care, daily activities and mobility. CONCLUSION At least five years after HE, cognitive, behavioral and daily functioning encompasses a broad spectrum that varies from profound retardation and almost total dependence to low normal cognition and a reasonably independent existence. Pre-existing contralateral MRI abnormalities reflect a more generally affected brain with a limited ability to mediate development after HE.
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Affiliation(s)
| | - Kees P J Braun
- Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
| | - Peter C van Rijen
- Department of Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
| | - Onno van Nieuwenhuizen
- Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
| | - Aag Jennekens-Schinkel
- Department of Pediatric Psychology, Sector of Neuropsychology, UMC Utrecht, Utrecht, The Netherlands; Department of Child Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands.
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Boshuisen K, van Schooneveld MMJ, Uiterwaal CSPM, Cross JH, Harrison S, Polster T, Daehn M, Djimjadi S, Yalnizoglu D, Turanli G, Sassen R, Hoppe C, Kuczaty S, Barba C, Kahane P, Schubert-Bast S, Reuner G, Bast T, Strobl K, Mayer H, de Saint-Martin A, Seegmuller C, Laurent A, Arzimanoglou A, Braun KPJ. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Ann Neurol 2015; 78:104-14. [DOI: 10.1002/ana.24427] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 04/07/2015] [Accepted: 04/12/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Kim Boshuisen
- Department of Child Neurology; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
| | | | - Cuno S. P. M. Uiterwaal
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | - J. Helen Cross
- Clinical Neurosciences; University College London Institute of Child Health, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London and Young Epilepsy; Lingfield United Kingdom
| | - Sue Harrison
- Neuroscience Department; University College London Institute of Child Health and Great Ormond Street Hospital for Children National Health Service Trust; London United Kingdom
| | | | | | | | - Dilek Yalnizoglu
- Department of Pediatric Neurology; Hacettepe University Children's Hospital; Ankara Turkey
| | - Guzide Turanli
- Department of Pediatric Neurology; Hacettepe University Children's Hospital; Ankara Turkey
| | | | | | | | - Carmen Barba
- Pediatric Neurology Unit; A. Meyer Children's Hospital-University of Florence; Florence Italy
| | - Philippe Kahane
- Neurology Department; Michallon Hospital, Grenoble Alpes University; Grenoble France
| | | | - Gitta Reuner
- University Children's Hospital; Heidelberg Germany
| | - Thomas Bast
- University Children's Hospital; Heidelberg Germany
- Kork Epilepsy Center; Kehl Germany
| | | | | | | | | | - Agathe Laurent
- Department of Epilepsy; Sleep, and Pediatric Neurophysiology, Woman Mother Child Hospital, University Hospitals of Lyon; Lyon France
| | - Alexis Arzimanoglou
- Department of Epilepsy; Sleep, and Pediatric Neurophysiology, Woman Mother Child Hospital, University Hospitals of Lyon; Lyon France
- Brain Dynamics and Cognition Team; Lyon Neuroscience Research Center; Lyon France
| | - Kees P. J. Braun
- Department of Child Neurology; Brain Center Rudolf Magnus, University Medical Center Utrecht; Utrecht the Netherlands
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Meekes J, van Schooneveld MMJ, Braams OB, Jennekens-Schinkel A, van Rijen PC, Hendriks MPH, Braun KPJ, van Nieuwenhuizen O. Parental education predicts change in intelligence quotient after childhood epilepsy surgery. Epilepsia 2015; 56:599-607. [DOI: 10.1111/epi.12938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Joost Meekes
- Sector of Neuropsychology for Children and Adolescents; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- Bio Research Center for Children; Arnhem The Netherlands
| | - Monique M. J. van Schooneveld
- Sector of Neuropsychology for Children and Adolescents; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Olga B. Braams
- Sector of Neuropsychology for Children and Adolescents; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- Bio Research Center for Children; Arnhem The Netherlands
| | - Aag Jennekens-Schinkel
- Sector of Neuropsychology for Children and Adolescents; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
- Bio Research Center for Children; Arnhem The Netherlands
| | - Peter C. van Rijen
- Department of Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Marc P. H. Hendriks
- Department of Behavioural Sciences; Kempenhaeghe Expertise Centre for Epileptology, Sleep Medicine and Neurocognition; Heeze The Netherlands
- Donders Institute for Brain; Cognition and Behavior; Radboud University Nijmegen; Nijmegen The Netherlands
| | - Kees P. J. Braun
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Onno van Nieuwenhuizen
- Bio Research Center for Children; Arnhem The Netherlands
- Department of Child Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
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Koenraads Y, van der Linden DCP, van Schooneveld MMJ, Imhof SM, Gosselaar PH, Porro GL, Braun KPJ. Visual function and compensatory mechanisms for hemianopia after hemispherectomy in children. Epilepsia 2014; 55:909-17. [PMID: 24754334 DOI: 10.1111/epi.12615] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Yvonne Koenraads
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - Monique M. J. van Schooneveld
- Department of Pediatric Psychology; Sector Neuropsychology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Saskia M. Imhof
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - P. H. Gosselaar
- Department of Neurosurgery; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
| | - Giorgio L. Porro
- Department of Ophthalmology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Kees P. J. Braun
- Department of Pediatric Neurology; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht The Netherlands
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van Buuren LM, van der Aa NE, Dekker HC, Vermeulen RJ, van Nieuwenhuizen O, van Schooneveld MMJ, de Vries LS. Cognitive outcome in childhood after unilateral perinatal brain injury. Dev Med Child Neurol 2013; 55:934-40. [PMID: 23758403 DOI: 10.1111/dmcn.12187] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
AIM The aim of the study was to assess cognitive outcome in children with periventricular haemorrhagic infarction (PVHI) or perinatal arterial ischaemic stroke (PAIS) and relate these findings to early developmental outcome and neonatal magnetic resonance imaging findings. METHOD A neuropsychological assessment was performed in 50 children (26 males, 24 females) with unilateral PVHI (n=21) or PAIS (n=29) at a median age of 11 years 9 months (range 6-20y). This included tests for intelligence, verbal memory, visual-motor integration, word comprehension, attention, reaction times, and executive function. The Griffiths Mental Development Scale was used for early developmental assessment at 24 months (range 18-32mo). RESULTS In children with PVHI, both the early Griffiths scores (mean 87; 95% CI 83-92) and the Full-scale IQ (FSIQ) scores at school age (mean 86; 95% CI 78-94) were below the test mean of 100. In the PAIS group, early Griffiths scores were within the normal range (mean 98; 95% CI 93-104), but at school age FSIQ scores were below average (mean 87; 95% CI 80-94). In children with PVHI, FSIQ scores correlated with the level of maternal education and were lower after ventricular dilatation, whereas both involvement of the basal ganglia and thalami and development of postneonatal epilepsy were associated with lower cognitive outcome in children who had experienced PAIS. INTERPRETATION Cognitive outcome after PVHI or PAIS is below average, but still within 1SD for most children. Prediction of cognitive outcome remains challenging, but some early predictors can be recognized.
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Affiliation(s)
- Lenny M van Buuren
- Department of Paediatric Neuropsychology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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de Koning T, Versnel H, Jennekens-Schinkel A, van Schooneveld MMJ, Dejonckere PH, van Rijen PC, van Nieuwenhuizen O. Language development before and after temporal surgery in children with intractable epilepsy. Epilepsia 2009; 50:2408-19. [DOI: 10.1111/j.1528-1167.2009.02264.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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