Neuropsychological assessments in a large cohort of pediatric palliative epilepsy surgery patients.

BACKGROUND

Pediatric patients with drug-resistant epilepsy (DRE) are often referred for evaluation to consider epilepsy surgery. Neuropsychological testing is recommended for all patients undergoing surgical evaluation. Prevalence and factors affecting testing of neuropsychological testing in palliative epilepsy surgery are unknown.

METHODS

Data was collected from the PERC surgical database, a collaboration of pediatric epilepsy centers prospectively enrolling pediatric patients undergoing epilepsy surgery evaluation. Pediatric patients with DRE who sought care at PERC centers, underwent first-time palliative epilepsy surgery, and had neurocognitive data collected were included.

RESULTS

569 patients had complete data with some form of neuropsychological assessment documented. Patients with focal motor (0.42 [CI 95% 0.28, 0.62] < 0.01) or cognitive delays (0.20 [CI 95% 0.13, 0.31] < 0.01) were less likely to receive neuropsychological testing, as were those with genetic etiology (0.5x, [CI 95% 0.33, 0.75] p < 0.01). The number of domains evaluated within corpus callosotomy (CC) (median 3, (1-9) < 0.01) and hemispherectomy (median 4 (1-9) <  0.01) groups was significantly lower than testing in other surgical groups. In addition the cognitive IQ and adaptive IQ were lower in patients undergoing CC and compared to other groups.

CONCLUSIONS

All types of patients undergoing palliative epilepsy surgery had some neuropsychological testing. However, those with lower IQ and those undergoing CC or hemispherectomy were less likely to undergo testing. Reduced rates of testing in certain groups indicates room for improvement, especially given recommendations to use testing to help determine surgical success.