Cognitive functioning after epilepsy surgery in children with mild malformation of cortical development and focal cortical dysplasia

• Published in: Epilepsy & behavior Vol. 94; pp. 209 - 215
• Main Authors: Veersema, Tim J., van Schooneveld, Monique M.J., Ferrier, Cyrille H., van Eijsden, Pieter, Gosselaar, Peter H., van Rijen, Peter C., Spliet, Wim G.M., Mühlebner, Angelika, Aronica, Eleonora, Braun, Kees P.J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019
• Subjects: Epilepsy surgery; Focal cortical dysplasia; Intelligence; Mild malformation of cortical development; Refractory epilepsy; EE; Refractory epilepsy; mMCD; Focal cortical dysplasia; Intelligence; FCD; IQ; Epilepsy surgery; AEDs; DQ; Mild malformation of cortical development
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2019.03.009

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. •51% of the children with mMCD or FCD had cognitive impairment prior to epilepsy surgery.•Cognitive impairment was associated with early onset and FCD type I histology.•Two years after surgery, a cognitive improvement of ≥10 IQ points was found in 24% of children.•At two years follow-up, there was no association between improved cognition and seizure status.