Epilepsy surgery preserved intellectual functioning, particularly in FL and PC procedures, however, persistent VCI decline in H and TL groups suggests effects on verbal abilities associated with temporal lobe involvement, and group-level trajectories rather than individual outcomes.
Abstract
Objective
To examine the impact of the operated brain region and clinical-surgical variables on intellectual performance in children and adolescents undergoing neurosurgery for pharmacoresistant epilepsy.
Methods
Fifty-one participants were classified according to surgical site: temporal lobe (TL; n = 23), frontal lobe (FL; n = 9), posterior cortex (PC; n = 9), and hemispherotomy (H; n = 10). Neuropsychological assessment was performed using age-appropriate versions of the Wechsler Intelligence Scales (Wechsler Intelligence Scale for Children/Wechsler Adult Intelligence Scale [WISC/WAIS]). Bayesian linear mixed models compared intelligence quotients and scale indices across three time points: preoperative (T0), 6-month postoperative (T1), and 24-month postoperative (T2). For each outcome, two models were fitted: a simple model and a multiple model adjusted for seizure frequency and epilepsy duration. Estimates were derived from posterior distributions with 95% credibility intervals. Analyses were conducted in R using MCMC sampling, with convergence assessed by trace plots and the Gelman-Rubin diagnostic. A change of ≥10 points was considered a clinically relevant improvement, whereas a decrease of ≥5 points indicated a relevant decline in longitudinal within-group comparisons. Results reflect group-level trajectories rather than individual outcomes.
Results
At T1, the H group showed declines in Full-Scale Intelligence Quotient (FSIQ), Verbal Comprehension Index (VCI), Perceptual Organization Index (POI), Working Memory Index (WMI), and Processing Speed Index (PSI). At T2, the FSIQ, POI, and WMI returned to near baseline, whereas VCI and PSI remained reduced. The TL group showed declines in VCI, WMI, and PSI at T1, with a persistent reduction in VCI at T2. FL and PC groups maintained intelligence indices close to baseline at both postoperative assessments.
Significance
Epilepsy surgery preserved intellectual functioning, particularly in FL and PC procedures. However, persistent VCI decline in H and TL groups suggests effects on verbal abilities associated with temporal lobe involvement. Sustained PSI reduction after hemispherotomy may indicate decreased cognitive efficiency and slower information processing.
Abstract Objective This study aimed to assess long‐term memory outcomes in patients with temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) or selective amygdalohippocampectomy (SAH), compared to nonoperated TLE over a 10‐year follow‐up period. Methods A total of 48 participants were studied: 10 ATL, 26 SAH, and 12 patients with nonoperated mesial temporal lobe epilepsy (MTLE). Verbal memory was assessed using the Sözel Bellek Süreçleri Testi (SBST—a test of verbal memory processes), and nonverbal memory was evaluated with the Wechsler memory scale—visual reproduction (WMS) (Turkish adaptation). Given the small and unbalanced groups, linear mixed‐effects models (LMMs) were used as the primary inferential analyses to test group × time interactions. Statistically reliable individual changes were identified using the reliable change index (RCI). Neuropsychological outcomes were analyzed longitudinally over a 10‐year follow‐up period. Results A significant group × time interaction was observed for verbal total learning (p = 0.001). The nonoperated TLE group showed a significant decline over time, whereas both surgical groups differed significantly from it. The ATL group demonstrated significant improvement. For delayed verbal recall, a significant main effect of group was observed; however, the group × time interaction was not statistically significant. Visual immediate recall showed a significant group × time interaction (p = 0.004), with a significant interaction effect in the ATL group. Visual delayed recall demonstrated a significant group × time interaction (p < 0.001), with significant interaction effects in both surgical groups. Seizure freedom was achieved in 90% of ATL and 80% of SAH cases; however, seizure outcome was not significantly associated with memory outcomes. Reliable change index analyses indicated lateralization‐dependent patterns of change. Significance ATL, particularly left‐sided ATL, was associated with statistically significant long‐term improvements in verbal memory and significant longitudinal changes in visual memory. SAH demonstrated significant longitudinal effects in selected memory domains. In contrast, nonoperated TLE patients showed significant cognitive decline over time. These findings highlight differential long‐term cognitive trajectories across treatment approaches and the role of lateralization in memory outcomes following epilepsy surgery. Plain Language Summary We examined memory changes over 10 years in people with temporal lobe epilepsy who underwent different surgical treatments or received medical management alone. Patients who underwent anterior temporal lobectomy (ATL), particularly on the left side, showed improvement in certain memory measures over time. Those who had selective amygdalohippocampectomy (SAH) demonstrated more domain‐specific cognitive changes despite good seizure control. In contrast, patients who did not undergo surgery experienced a decline in verbal learning. These findings suggest that surgical approach and brain lateralization play important roles in long‐term memory outcomes.
Tehran Aliyeva, Fadime Çadırcı Tungaç, Beyza Tağraf et al.· Epilepsia Open· 0 citations
Palliative surgical procedures for pediatric DRE are safe and associated with seizure reduction, decreased medication burden, and gradual improvement in adaptive functioning and early surgical intervention may help minimize developmental decline and improve long-term adaptive outcomes.
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It is suggested that establishing routine FLE services in countries with limited resources is feasible, and a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.
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Postoperative ASM reduction was associated with domain-specific cognitive improvement following ATL, particularly in WM, which support ASM tapering as a potentially modifiable factor influencing postoperative cognitive outcomes.
Kazushi Ukishiro, S. Osawa, M. Ogawa et al.· Epilepsia· 0 citations
The timely detection of cognitive impairment in pediatric epilepsy is a pressing issue in neurological practice. This study examined cognitive changes in children aged 5 to 17 years (inclusive) with temporal lobe epilepsy (26 subjects) and self-limited epilepsy with centrotemporal spikes (22 subjects). The control group consisted of 32 healthy volunteers aged 6 to 17 years (inclusive). A comparative analysis of cognitive testing results using the Wechsler cognitive assessment (child and adult versions) revealed multiple changes in verbal and nonverbal functions in patients with epilepsy compared to the control group. Patients with self-limited epilepsy with centrotemporal spikes also showed more pronounced changes in verbal IQ, with scores decreasing relative to the group of patients with temporal lobe epilepsy and the control group. A correlation was also noted between a right-sided focus of epileptiform activity and statistically significantly lower scores on the nonverbal IQ subtests. Similarities in cognitive profile changes were also observed in patients with genetic and structural focal epilepsy. However, the diffuse changes revealed by the test results were consistent with normal IQ scores. The findings demonstrate the widespread influence of epileptogenic processes on the development of cognitive functions, as well as the high compensatory capacity of children. Thus, neuropsychological examination of children with epilepsy already at the early stages of the disease can reveal deviations in the development of cognitive status, which can significantly affect the further development and socialization of pediatric patients and necessitates the organization of neuropsychological screening for this pathology.
A. Paramonova, A. A. Vasilieva, Е. Е. Timechko et al.· Vestnik of North-Eastern Fed...· 0 citations
WMH are common in adults with focal epilepsy, and the frontal lobe is the most frequently affected region, and age, seizure duration, interictal epileptiform discharges, and seizure duration are independent risk factors for greater WMH burden.
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