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Abstracts

Comparison of the Cognitive Lateralization Rating Index between Pediatric Epilepsy Surgery Patients and the General Pediatric Epilepsy Population

Abstract number : 2.037
Submission category : 11. Behavior/Neuropsychology/Language / 11B. Pediatrics
Year : 2025
Submission ID : 669
Source : www.aesnet.org
Presentation date : 12/7/2025 12:00:00 AM
Published date :

Authors :
Hope Reecher, BS – Medical College of Wisconsin
Presenting Author: Sydney Park, PhD – Medical College of Wisconsin

Avantika Singh, MD – Medical College of Wisconsin
Irene Kim, MD – Medical College of Wisconsin
Sean Lew, MD – Children's Wisconsin, Medical College of Wisconsin
Jennifer Koop, PhD – Medical College of Wisconsin

Rationale: Determination of hemispheric dominance of language functions is an essential component of the presurgical epilepsy evaluation. The utility of the Cognitive Lateralization Index (CLRI) has been examined in a pediatric surgical cohort [1] but not in nonsurgical cohorts [2]. The aim of this study was to examine differences in cognitive lateralization between surgical and nonsurgical pediatric epilepsy patients. We hypothesized that the surgical cohort would have a greater frequency of lateralized profile(s).

Methods: Retrospective chart review and screening was completed for patients under the age of 18 with a diagnosis of epilepsy who were surgical (medically-refractory, including phase II stereotactic EEG) and nonsurgical (deemed not a surgical candidate by primary neurologist). Lateralization was determined by scalp EEG for nonsurgical, and, if available, by invasive stereotactic EEG in surgical patients. Patient charts were screened for a neuropsychology evaluation with sufficient data to calculate the CLRI. Primary analyses included frequency, descriptive, and X2 tests.

Results: A total of 82 patients were included in this study (36 female and 46 male) with 35 surgical and 47 nonsurgical patients. Mean seizure onset age was 5.02 years (SD 3.79), mean age at surgery was 11.4 years (SD 3.93), and mean neurology follow-up duration post-neuropsychology evaluation for CLRI calculation was 24.2 months (SD 18.4). Of the 80 patients with a listed etiology, 22.5% had a congenital structural etiology. Surgical patients had predominantly focal epilepsy (31/35, 88.6%). Most of the cohort had a mild (± 1) degree of lateralization (37/82, 45.1%). Most patients had a nondominant CLRI (49/82, 59.8%), but only a small proportion showed a nonlateralized CLRI (7/82, 8.5%). Patients with right hemispheric and generalized/multifocal seizure lateralization more often had a non-dominant CLRI (Table 1). There was no significant difference between the degree of lateralization between surgical and nonsurgical patients, X2 (3, N=82)=1.34, p=0.72), nor between the 3 CLRI categories, X2 (2, N=82)=3.20, p=0.20) (Table 2). Further analyses with cognitive data are pending.

Conclusions: Findings from this study encourage the generalizability of the CLRI in the pediatric population, both in surgical and nonsurgical epilepsy patients, and can be utilized to detect lateralized profiles in these populations. Despite significant differences between seizure lateralization, there were no significant differences in cognitive lateralization i.e., CLRI groups.

Funding:

None. 

References 

  1. Wozniak BD, Loman MM, Koop JI. Assessing risk: Characterizing language performance in pediatric patients with intractable epilepsy pre- and post-surgical resection. Epilepsy Behav. 2021;115:107603.  

  1. Reecher HM, Park SE, Ailion A, et al. Association of the cognitive lateralization rating Index with surgical variables of a national cohort of pediatric patients with epilepsy. Epilepsy Behav. 2025 Jul;168:110404. 



Behavior