Neuropsychological outcome after frontal surgery for pediatric-onset epilepsy with focal cortical dysplasia in adolescent and young adult

• Published in: Epilepsy & behavior 2024-04, Vol.153, p.109687-109687, Article 109687
• Main Authors: Kimura, Nobusuke, Takahashi, Yukitoshi, Usui, Naotaka, Matsuda, Kazumi, Otani, Hideyuki, Kasai, Yoshinobu, Kondo, Akihiko, Imai, Katsumi, Takita, Junko
• Format: Article
• Language: English
• Subjects: Adolescence and young adulthood; Epilepsy surgery; Focal cortical dysplasia; Frontal lobe epilepsy; Neuropsychological outcome; Pediatric epilepsy
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2024.109687

•Approximately 75% of patients showed some improvement or no change in individual neuropsychological tests after frontal resection but 25% showed declined outcome.•Patients with language-dominant side resection showed declined Vocabulary and Phonemic Fluency (5/15 patients), but improved WCST-Category (7/14), Block Design (6/15), Digit Symbol (4/15) and Delayed Recall (3/9).•Patients with language-nondominant-side resection showed improved Vocabulary (3/12 patients), but declined Block Design (2/9) and WCST-Category (2/9), especially for dorsolateral frontal cortex resection. Arithmetic (3/10) declined after dorsolateral frontal cortex or ventrolateral frontal cortex resection.•General Memory, Visual Memory and Delayed Recall (3/8 patients), Verbal Memory (2/9), and Digit Symbol (3/12) also declined after language-non-dominant-side resection. We investigated neuropsychological outcome in patients with pharmacoresistant pediatric-onset epilepsy caused by focal cortical dysplasia (FCD), who underwent frontal lobe resection during adolescence and young adulthood. Twenty-seven patients were studied, comprising 15 patients who underwent language-dominant side resection (LDR) and 12 patients who had languagenondominant side resection (n-LDR). We evaluated intelligence (language function, arithmetic ability, working memory, processing speed, visuo-spatial reasoning), executive function, and memory in these patients before and two years after resection surgery. We analyzed the relationship between neuropsychological outcome and resected regions (side of language dominance and location). Although 75% of the patients showed improvement or no change in individual neuropsychological tests after surgical intervention, 25% showed decline. The cognitive tests that showed improvement or decline varied between LDR and n-LDR. In patients who had LDR, decline was observed in Vocabulary and Phonemic Fluency (both 5/15 patients), especially after resection of ventrolateral frontal cortex, and improvement was observed in WCST-Category (7/14 patients), Block Design (6/15 patients), Digit Symbol (4/15 patients), and Delayed Recall (3/9 patients). In patients who underwent n-LDR, improvement was observed in Vocabulary (3/12 patients), but decline was observed in Block Design (2/9 patients), and WCST-Category (2/9 patients) after resection of dorsolateral frontal cortex; and Arithmetic (3/10 patients) declined after resection of dorsolateral frontal cortex or ventrolateral frontal