Work

Cognition in adults with bottom‐of‐sulcus dysplasia and the consequences of focal resection

Year: 2026

Type: article

Abstract: OBJECTIVE: To determine whether there are cognitive consequences of bottom-of-sulcus dysplasia (BOSD) when assessed as adults and whether focal resection of these lesions leads to change in cognition. METHODS: We studied 42 adults, of whom 39 underwent focal resection targeting the lesion. Neuropsychological assessments were tailored to the clinical epileptology. RESULTS: On average, patients were 30 (15-56) years old at the time of assessment. Epilepsy duration was 21 (3-48) years. Seizure onset ranged between 3 months and 26 years. Fifteen patients (36%) had an age of onset of 12 years or older. Older age of seizure onset correlated with fewer cognitive measures impacted (r = -0.34, p = .026). Frontal (52%) and parietal (33%) lobes were common BOSD locations. Confrontation naming was assessed in 20 patients, 11 (55%) of whom were impaired. Of these 11 patients, 8 (73%) had a left-sided BOSD. Verbal fluency was assessed in 23 patients, 13 (57%) of whom were impaired. Of these 13 patients, 11 (85%) had a frontal BOSD. Processing speed and attention were assessed in 35 patients and deficits were seen in 17% to 20%, though milder reductions were more consistently seen. At post-surgical follow-up (M = 8.07 years, SD = 4.91 years), 59% of patients were seizure free. As a group, there was no evidence of post-surgical cognitive decline after focal resection of the BOSD; processing speed (p < .05) improved post-surgically. SIGNIFICANCE: In adults with BOSD, an earlier age of seizure onset is accompanied by a greater degree of cognitive comorbidity. Naming is commonly affected, particularly for those with left sided BOSDs. Executive dysfunction is common, particularly for patients with a frontal BOSD. Focal lesionectomy is associated with favourable seizure outcome and is cognitively safe with potential for improvement in processing speed.

Source: Epilepsia

DOI: 10.1002/epi.70116

Authors: Carmen J. Zheng, David Weintrob, Marie O'Shea, Graeme D. Jackson, Chris Tailby

Institutions: The University of Melbourne, Florey Institute of Neuroscience and Mental Health, Austin Health, Austin Hospital

Language: English

Topic: Epilepsy research and treatment

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,360