Abstracts

Rationale: Corpus Callosotomy (CC) is an effective surgical treatment for drug resistant epilepsy reducing seizure burden (Baumgartner, et al., 2023; Hansen et al, 2023). Measuring surgical success is essential including neuropsychological testing, yet testing is not consistently administered. There is little research on premorbid characteristics of CC patients; most studies focus on adults with small sample sizes (Passamonti, et al., 2014; Spencer et al., 1993). This project investigates differences in pediatric patients who undergo neuropsychological assessment prior to CC compared to those who do not.


Methods: From the Pediatric Epilepsy Research Consortium Surgery Database, a multicenter, observational study including 27 US pediatric epilepsy centers, 174 patients underwent CC. We compared patients receiving neuropsychological testing to those not tested prior to CC to determine if patient characteristics influence likelihood of receiving testing. Additionally, we compared practices at centers that typically conduct testing to those who test fewer patients. We analyzed two centers with highest volume of CC procedures and testing 50% of more of their patients (Cook Children’s n=51 and Nationwide Childrens n=18). Centers performing fewer than 15 CC and testing less than 50% of patients were combined (n=89). Chi Square was used for analyses except Fisher’s Exact Test was used for Nationwide due to smaller sample size.


Results: Only 52 (30%) had neuropsychological testing performed. Overall, there were no differences between those who received neuropsychological testing and those who did not. There was a trend for those with normal neurological exam to be more likely to receive testing. (p =.06). Among centers performing more CC, White/Non-Hispanic patients at Cook Children’s were slightly more likely to undergo testing than the combined under-represented groups (p=.049). At centers performing fewer CC, those failing more antiseizure medications were more likely to be tested (p= .01) as were those with normal neurological exam (p=.02). See Tables 1 and 2.

Conclusions:





Results indicate across centers there were no differences between patients who receive neuropsychological testing prior to CC and those who did not. There was a trend across centers for those with normal neurological exam to be tested suggesting lower functioning patients may not be referred for testing; indeed, patients in this sample tended to be low functioning (mean Adaptive Behavior Assessment Survey standard score = 63) and may not be able to complete a test battery. However, most patients’ functioning can be captured with at least one standardized measure so evaluations should be completed. Investigating social determinants of health will elucidate barriers to care for minorities less likely to receive neuropsychological testing. Continuing to follow CC patients will provide data on whether CC improves functioning in addition to seizure control. Future studies can elucidate tests most sensitive to change in this population with lower cognition and limited verbalizations.





Funding: Pediatric Epilepsy Research Foundation