Abstracts

Intellectual and social-emotional functioning in children and adolescents who undergo temporal lobe resection due to intractable seizures is poorly understood.
We retrospectively reviewed data of children who underwent temporal lobe resection (5 right, 6 left) for refractory epilepsy. Eleven children (8 boys, 3 girls), aged 7 to 16 at time of surgery (Mean = 11.5 years), had documented temporal lobe epilepsy with a mean age of onset at 4 years old (range = 1 to 8.5 years). Eight children had mesial temporal sclerosis (MTS), 2 dysplasia, and 1 vascular malformation based on magnetic resonance imaging (MRI) and histopathological findings. All children had a comprehensive neurological and neuropsychological evaluation prior to and following surgery. Presurgical evaluation typically occurred within 6 months (range = 2-6 months) of surgery; however one child[apos]s neuropsychological data was collected 48 months prior. Time since surgery for follow-up varied from 7 to 75 months (Mean = 18 months). Neuropsychological measures analyzed in this study included the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) and the Child Behavior Checklist (CBCL) (n = 8). Descriptive data was used to characterize seizure outcome and repeated measures analysis of variance (ANOVA) were used to assess pre- and postoperative neuropsychological outcome.
Ten of 11 children (90.9%) were seizure-free (Engel outcome class I) and 1/11 (9.1%) had significant reduction in seizures (Engel class II). Patients demonstrated average intellectual functioning prior to (Mean pre FSIQ = 92) and after surgery (Mean post FSIQ = 91). Similarly, in this population, no clinically significant social or emotional symptomatology was reported pre- (Mean CBCL Total T score = 61) or post surgery (Mean CBCL Total T score = 50). Repeated measures ANOVA revealed no significant changes in Full Scale IQ (F = .001, p = .980), Performance IQ (F = .031, p = .864), or Verbal IQ (F = .463, p = .512). Post-surgical changes did not reach significance on the CBCL Total score (F = 3.182, p = .118) or CBCL Externalizing score (F = .647, p = .448); however, a trend towards significance was evident on reduced CBCL Internalizing scores (F = 4.359, p = .075). Further analysis of subscale scores showed trends toward improved attentional functioning (F = 4.163, p = .08) and less depressed and anxious symptoms (F = 2.902, p = .132).
Children who underwent temporal lobe resection showed no significant change in cognitive functioning following surgery, which overall fell within the average range. A trend in reduction of attentional symptoms as well as anxiety and depression was found. CBCL scores were improved, on average, by a standard deviation, suggesting improved social-emotional functioning following surgery.
[Supported by: Epilepsy Foundation Student Fellowship]