Pediatric frontal lobe epilepsy surgery: long-term neuropsychological outcomes and their predictors.

OBJECTIVE

Medium- to long-term neuropsychological outcomes after pediatric frontal lobe surgery are not well characterized. We aimed to describe domain-specific outcomes and their clinical predictors in a large pediatric cohort.

METHODS

This observational study compared pre- and postoperative full-scale IQ (FSIQ), expressive language, visuomotor skills, attention/working memory, executive functions, memory, behavior, and adaptive abilities in children who underwent frontal lobe epilepsy surgery. Clinically significant change was defined using effect-adjusted reliable change indices or, when unavailable, a > 1.0 SD cutoff. Demographic, epilepsy-related, and neurosurgical factors were examined as predictors.

RESULTS

Seventy-eight children underwent neuropsychological evaluations a median of 2.5 years (full range 0.5-13 years) after surgery. Across domains, 72% remained stable, 13% improved, and 15% declined, with visuomotor skills showing the highest decline rate and executive functions the highest improvement rate. Engel Class I outcomes were associated with stability or improvement in FSIQ, attention/working memory, adaptive behavior, and visuomotor skills. Younger age at epilepsy onset predicted declines in expressive language and in attention/working memory. Tumor and vascular etiologies predicted stability/improvement, whereas multiple lesions predicted declines across cognitive, executive, adaptive, and behavioral domains. Resections involving the ventromedial/orbitofrontal or anterior cingulate regions were associated with FSIQ decline. Extensive resections were linked to attention/working memory and behavioral decline. Undergoing preoperative sEEG coincided with multi-domain stability/improvement.

CONCLUSIONS

Medium- to long-term neuropsychological outcomes after pediatric frontal lobe surgery are largely preserved or improved. Etiology, resection extent, and involvement of ventromedial/orbitofrontal networks strongly influence outcomes, underscoring the importance of early evaluation, detailed network mapping, and surgical precision.