Language development after epilepsy surgery

Grant round winners 2011

When epilepsy develops in childhood, it often leads to learning and behavioural problems, particularly when seizures continue for a number of years. Approximately one-third of children with epilepsy do not respond to anti-epileptic drug treatment, and a proportion of these children might be considered for epilepsy surgery to remove the area of the brain in which their seizures originate (the epileptic focus).

Prior to performing surgery, a neurosurgeon needs to obtain an accurate image of the child’s brain and the areas in which important functions (such as language) reside, to avoid removing or damaging them during the operation. This is achieved using imaging and neuropsychological testing. However, children’s seizures often originate in one of these critical brain regions, and this makes the decision of whether or not to operate even more difficult. If it is decided that surgery should go ahead, the area will be removed.

The so called ‘eloquent language areas’ are located in the frontal, parietal and lateral temporal lobes of the brain. Dr Torsten Baldeweg and colleagues at the Institute of Child Health, University College London have been awarded £99,805, over 24 months, to carry out a project entitled Plasticity of Language Networks after Surgical Resection in Childhood Epilepsy: Implications for Outcome. In this they will try and find out the extent to which the developing brain can compensate for the removal of one of these regions, and how language/cognitive development after this type of surgery is affected.

The team will focus on a group of 80 children who underwent pre-surgical investigations, including language and neuropsychological assessment, at Great Ormond Street Hospital, London, between 2006 and 2009. 46 of these children had surgery and are between three and five years post-operation. The 34 children who did not have surgery will serve as non-surgical controls.

The 80 children will be invited to perform further neuropsychological, language, intellectual ability and quality of life tests, and the ‘before’ and ‘after’ surgery results will be compared. The control and surgery groups will then be matched for variables such as IQ and lesion severity and the outcomes of the two will be compared. The researchers will also investigate whether imaging scans obtained before and after surgery are predictive of a favourable outcome in the children who underwent surgery.

Dr Baldeweg and his colleagues believe that this project may help to provide important evidence supporting the need for improved cognitive, educational and psychosocial outcomes in children who have epilepsy surgery.

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