Pediatric Patients With FCD, LEAT Exhibit No Significant Changes in IQ, QOL After Surgery

Pediatric patients with facial cortical dysplasia (FCD) and long-term epilepsy-associated tumors (LEAT) who undergo epilepsy surgery do not experience significant changes in their cognitive function or quality of life (QOL), say findings from a systematic review and meta-analysis published in Epilepsy Research.

The compilation of data came from over 900 patients across 19 studies. Among them, 12 reported on IQ and developmental quotient (DQ). Data from these studies showed there were no significant changes in IQ or DQ following surgery. Among the 500 patients included in the IQ-/DQ-focused studies, the preoperative mean (SD) IQ/DQ was 69.32 and the postoperative mean IQ/DQ was 69.98 (SMD = − 0.16; 95% CI, −0.50 to 0.18]; P = .32). The findings suggest that there is no consequential relationship between seizures and cognitive function.

“An alternative explanation of the results is related to the fact that in a large proportion of patients, the preoperative trajectory can be adverse, with aspects such as baseline cognition, functional plasticity level, and level of seizure control being relevant in establishing this,” wrote the researchers. “In these individuals a null change between the pre- and postoperative IQ score equates with a successful surgical outcome, potentially leading to an improved trajectory compared to no surgical treatment.”

The researchers also noted the possibility that the follow-up was not sufficient for an accurate depiction of the long-term effects of surgery on IQ and QOL. The group suggests a minimum follow-up of 5 to 10 years for pediatric patients receiving the surgery. No studies included in their review offered data on IQ or QOL at disease onset.

Just 2 studies reported on QOL for these patients following surgery. The pooled mean QOL estimates increased from 42.52 (95% CI, −14.94 to 99.98; I2 = 91.4%; P < .001; Q=11.60) before surgery to 55.50 (95% CI, −198.03 to 309.04; I2 = 98.6%; P < .001; Q=70.81) after surgery.

The QOL-focused studies were both heterogenous in the measures used and in the results observed; one study used the Quality of Life in Epilepsy Inventory (QOLIE)-31 questionnaire while the other used the QOLIE-89 test, and one study of patients with mixed pathologies showed a slight decrease in QOL while the other study of patients with FCD patients showed a large increase in QOL.

“The scarcity of QOL studies on lesional epilepsy patients should prompt towards an increased research interest in this particular area,” wrote the researchers. “Additionally, hospitals evaluating and treating patients with drug-resistant lesional epilepsy should incorporate regular QOL assessments as part of their pre- and postsurgical evaluations.”

Reference

Vasilica AM, Winsor A, Chari A, Scott R, Baldweg T, Tisdall M. The influence of disease course and surgery on quality of life in children with focal cortical dysplasia and long-term epilepsy-associated tumours: a systematic review and meta-analysis. Epilepsy Res. Published online March 30, 2023. doi:10.1016/j.eplepsyres.2023.107132