Neuropsychological outcomes after pediatric epilepsy surgery: Role of electrical stimulation language mapping. (August 2020)

• Record Type: Journal Article
• Authors: Sakpichaisakul, Kullasate; Byars, Anna W.; Horn, Paul S.; Aungaroon, Gewalin; Greiner, Hansel M.; Mangano, Francesco T.; Holland, Katherine D.; Arya, Ravindra
• Is Part Of: Seizure. Volume 80(2020)
• Page Start: 183
• Page End: 191
• Publication Date: 2020-08
• Subjects: ANCOVA analysis of covariance -- ATL anterior temporal lobectomy -- AED anti-epileptic drug -- BNT Boston Naming Test -- DRE drug-resistant epilepsy -- ESM electrical cortical stimulation mapping -- KMO Kaiser-Meyer-Olkin test -- LWI Letter Word Identification -- NPE neuropsychological evaluation -- PPVT Peabody Picture Vocabulary Test -- PIQ Performance Intelligence Quotient -- PC Principal Component -- PSI Processing Speed Index -- SMI/SMD Story Memory immediate and delayed recall respectively -- SOZ seizure-onset zone -- VIQ Verbal Intelligence Quotient -- VLI/VLD Verbal Learning immediate and delayed recall respectively -- VMI Visual Motor Integration (Beery-Buktenika test) -- WAIS Wechsler Adult Intelligence Scale -- WISC Wechsler Intelligence Scale for Children -- WMI Working Memory Index -- WPPSI Wechsler Preschool and Primary Scale of Intelligence -- WRAML Wide Range Assessment of Memory and Learning -- WJ Woodcock-Johnson Tests of Achievement; Functional brain mapping -- Intracranial EEG -- Cognitive outcomes -- Principal components analysis; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2020.06.029
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: In children >5 years, language mapping led to improved neuropsychological outcomes. This effect was more prominent in language non-dominant hemisphere surgeries. Seizure outcomes, age, and semiology also determine neuropsychological outcomes. Pre-surgical electrical stimulation language mapping should be performed more widely. Abstract: Purpose: We studied the association between electrical stimulation mapping (ESM) with a visual naming task and post-operative neuropsychological outcomes after pediatric epilepsy surgery. Methods: Children who underwent epilepsy surgery, having pre- and 1-year post-surgery neuropsychological evaluation (NPE) available, were included. NPE scores were transformed using principal components (PC) analysis. The relationship between post-surgical PC scores, adjusted for pre-surgery PC scores, and ESM was analyzed. Clinical variables influencing this relationship were also sought. Results: One hundred and four children (89 patients >5 years-old, and 15 patients 3−5 years-old) were included. Among children >5 years-of-age, a significant effect of language ESM was observed on all 3 post-surgery PC scores adjusted for respective pre-surgery PC scores. Specifically, only 30 % patients who underwent language ESM had a decrease in PC1 scores ≥1-year after epilepsy surgery, compared to 68 % those who did not undergo language ESM (p = 0.001). Seizure outcomes, age at the time of surgery, predominant seizure type, and family history of epilepsy were other significant determinants of post-surgical PC scores including a change in PC scores from pre-surgery baseline. Combinations of pre-surgical variables were able to predict post-surgical PC scores with high specificity. In children aged 3−5 years, no significant effect of language ESM was seen on post-surgery PC scores adjusted for respective pre-surgery PC scores. Conclusions: Speech/language ESM should be performed more widely in patients >5 years-of-age undergoing epilepsy surgery. Also, more efficient brain mapping techniques and language paradigms are needed for younger children.