Abstracts

Rationale: Frequent seizures in children are associated with compromised cognitive outcome and decreased white matter volume.¹ Early surgical resection for seizure control is associated with global mental delay² and may not improve outcome in some children,³ but cognitive gains occur in some children with seizure freedom following surgical resection for severe epilepsy at 2 to 6 years.⁴ Whether or not a subset of cognitively intact young patients could be spared global impairment with early focal resection has not been addressed. With this retrospective chart-review study, we sought to identify a subset of presurgically cognitively intact young children to evaluate this question. Methods: We retrospectively identified patients who had epilepsy surgery at Seattle Children s Hospital between 4/00 and 7/09, were 2 to 6 years, and had presurgical testing, focal epilepsy surgical resections, and post surgical testing. Patients with presurgical Wechsler Full Scale IQ scores < 80, large resections, and/or dual pathologies were excluded. 2 patients with no IQ testing were included because developmental screening showed average functioning.Results: 13 patients had focal surgical resections, 5 right and 8 left hemisphere, at 2 through 6 years (mean 60 months, range 23-82 months). All patients have remained seizure free since surgery, except 1 patient had 1 seizure with high fever, 1 had 2 seizures, and 1 had infrequent breakthrough seizures starting 10 months post resection with illness. The mean Wechsler FSIQ scores were 100 for 11 patients on average 2 months prior to surgery; 97 for 13 patients on average 9 months post; and 106 for 10 patients on average 43 months post surgery. 12 of 13 were on antiepileptic drugs (AEDs) presurgically; 12 of 13 were on AEDs during the 1st and 3 of 10 during the 2nd post surgical testing. Verbal and nonverbal score group means were similar, but some individuals had significant verbal-nonverbal score discrepancies.Conclusions: This preliminary pilot study suggests that surgical resection for seizure remediation in very young cognitively intact patients is likely to result in seizure reduction/control with AED discontinuation and also preservation of cognitive abilities. This study is limited by the small number of patients, the mixture of different Wechsler test versions that could yield somewhat different scores, the lack of very long term outcome measurement, and careful delineation of medication and medication effects. References: 1. Hermann B et al 2010. Brain development in children with new onset epilepsy: A prospective controlled cohort investigation.