Abstracts

Rationale: Pediatric focal frontal lobe epilepsy (FLE) is common, and when refractory may be treated with surgical resection of the seizure foci. Surgical resection in frontal areas may pose a risk to cognitive, language, executive functioning, and motor functioning. Post-operative risk is due to proximity of eloquent functional cortex. However, post-operative outcomes are difficult to predict due to heterogenous disease and patient factors, resulting in mixed outcomes research. We examined patients with right or left frontal Focal Cortical Dysplasia (FCD) and compared cognitive functioning before and after surgery to treat epilepsy.


Methods: Retrospective chart review was completed for 17 surgical patients (9 L-FLE; 8 R-FLE) with a post-surgical pathology finding of FCD at our institution from 2005-2023. Mean age of onset was 4.84 ± 4.70 years, mean disease duration was 4.24 ± 3.60 years, and mean follow up was 3.49 ± 2.69 years. Patients had baseline and post-operative neuropsychological evaluation 1.34 ± 1.13 years after surgery. Measures included age-appropriate Wechsler IQ measures, Grooved Pegboard, and Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). Post-surgical change was defined as ± 5 for standard scores and ± .3 for Z scores.

Results: Mean verbal and visual reasoning skills were in the low average to average range before and after surgery (L-FLE Pre: VCI=81, VSI=91; Post: VCI=91, VSI=96; R-FLE Pre: VCI=90, VSI=87; Post: VCI=90, VSI=86). In the whole sample, older age at surgery was associated with higher baseline verbal (r=.51, p< .05) and visual reasoning skills (r=.61, p< .05). Left sided lateralization was associated with an increase in nondominant grooved pegboard scores post-surgically (r=.65, p< .05). Qualitatively, on average post-operative change scores across measures were higher in the L-FLE when compared to R-FLE. Two people had a decline in verbal reasoning (1L/2R), 1 had decline in VMI (L), 6 had decline in Grooved Pegboard dominant hand (2L/4R), and 6 had decline on nondominant hand (1L/5R). At follow up, 71% were seizure free (L: 6/9; R: 6/8), and 8 patients achieved Engel 1a status (L: 4/6, R: 4/6).