Impact of epilepsy surgery on the development of young children with refractory seizures.
Description: The negative impact of severe focal epilepsy in childhood does not only result from the cerebral lesions which are at its origin or from its psychosocial consequences, but also from its interference with neuronal function and brain maturation. The epileptic activity can thus, besides visible seizures, prevent the child from learning and interacting with his environment. In this clinical research project, we prospectively followed a cohort of 11 young children (< 6 years) from whole Switzerland with refractory focal epilepsy who became seizure free after epilepsy surgery (Vaud-Geneva epilepsy surgery program). Our main aim was to better understand the role of the epilepsy itself on the development of these children by closely following the evolution of cognitive function before and after the procedure and correlating our findings with the different epilepsy related variables studied with brain imaging and electrophysiological techniques. We found that: 1) All the children had more or less severe developmental problems before surgery, regardless of the etiology of the epilepsy. 2) Short-term follow-up (1 year) quickly revealed 2 groups with different evolutions: children of group I with rapid cognitive gains and children of group II with no gain, even developmental slowing despite some behavioural improvement 3) Long term follow-up (3-6 years) mainly showed gradual stabilization of cognitive function or slow progress. The rapid cognitive gain in group I was attributed to the cessation of the intense epileptic activity that propagated from the focus to unaffected brain regions. The reason for the absence of cognitive recovery in group II remained more speculative: one can either assume that the epilepsy was only an epiphenomenon of an underlying more diffuse but invisible brain pathology of possibly genetic origin or, that the epileptic damage was already done in vulnerable networks crucial for development, so that its interruption did not change cognitive function. Significant cognitive gain cannot be expected from epilepsy surgery in young children with developmental delay unless specific conditions are fulfilled, that this project contributed to identify.
Amount: CHF 335,000
Funding type: research
Funder scheme: Project funding
Start date: 2003-01-01
End date: 2007-12-31
Investigator: Roulet-Perez, Eliane
Institution: University of Lausanne – LA
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Funded outputs count: 1
Funder award ID: 68105
OpenAlex ID: G7071025672