Abstracts

Existing data suggest that, with the exception of diminished verbal memory, cognitive ability is stable following temporal lobectomy. However, few studies have examined postoperative outcome by side of surgery or assessed cognitive functions other than IQ or memory. This study was aimed at clarifying language outcome following DTL in pediatric patients and factors that may moderate risk of language decline.
Records of 11 pediatric patients (5 female, 6 male) of normal IQ who underwent DTL were reviewed. Patients[apos] seizures were either cryptogenic or symptomatic (i.e. low grade tumor, mesial temporal sclerosis). Five were bilateral and 6 were left hemisphere language dominant. Follow-up ranged from 4 to 38 months (median=9 months). Ten patients achieved complete seizure control and one experienced only infrequent seizures postoperatively. Pre and postoperative scores were compared on the following variables: VIQ, confrontation naming (CN), repetition speech (RS), language comprehension (LC), verbal fluency (VF), word reading (WR), and phonics skills(P). Patients were considered to have improved or declined if their classification changed, such as from Average to Low Average. Outcome was examined with respect to follow-up interval, age of seizure onset, and left vs bilateral language.
Ten of 11 patients declined in at least one modality, but only 4 patients declined from normal to the impaired range. Among those who experienced decline to the impaired range, decline was limited to VF in 2 patients, CN in 1 patient, and CN and LC in 1 patient. These declines were not perceived by families as problematic, with the exception of the patient whose decline was limited to CN, and this patient was evaluated only 4 months postoperatively. Age of seizure onset was later in those who experienced decline to the impaired range in at least one modality (10.7 years) than in those who maintained normal language functions in all respects (3.8 years, p=.02). There was a trend for postoperative interval to be briefer (7 months vs. 13.7 months,p=.18) in those who experienced decline to the impaired range in at least one modality. Three of 6 left dominant patients and only 1 of 5 bilateral patients experienced decline to the impaired range, although the relationship between hemispheric dominance and language outcome fell short of clinical significance. Most patients experienced stable or improved functioning in each modality.
Most patients experience stable or improved language functions postoperatively, and when decline from normal to impaired performance was observed, it usually was not perceived as interfering significantly with the patient[rsquo]s day to day functioning. Because postoperative interval was typically shorter in those experiencing a decline than in those who did not, observed declines may represent as-yet incomplete recovery from surgery. Bilateral language representation may provide some protection against significant language decline.