Cognitive and developmental outcomes after pediatric insular epilepsy surgery for focal cortical dysplasia

View More View Less
  • 1 Departments of Neurosurgery and
  • 4 Child Neurology, Epilepsy Center, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo;
  • 2 Department of Neurosurgery, Epilepsy Center, Yokohama City University School of Medicine, Yokohama, Kanagawa;
  • 3 Department of Health and Nutrition, Faculty of Health and Nutrition, Osaka Shoin Women’s University, Higashi-Osaka, Osaka;
  • 5 Department of Neurosurgery, Shibukawa Medical Center, Shibukawa, Gunma; and
  • 6 Epilepsy Hospital Bethel Japan, Iwanuma, Miyagi, Japan
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Cognitive risk associated with insular cortex resection is not well understood. The authors reviewed cognitive and developmental outcomes in pediatric patients who underwent resection of the epileptogenic zone involving the insula.

METHODS

A review was conducted of 15 patients who underwent resective epilepsy surgery involving the insular cortex for focal cortical dysplasia, with a minimum follow-up of 12 months. The median age at surgery was 5.6 years (range 0.3–13.6 years). Developmental/intelligence quotient (DQ/IQ) scores were evaluated before surgery, within 4 months after surgery, and at 12 months or more after surgery. Repeated measures multivariate ANOVA was used to evaluate the effects on outcomes of the within-subject factor (time) and between-subject factors (resection side, anterior insular resection, seizure control, and antiepileptic drug [AED] reduction).

RESULTS

The mean preoperative DQ/IQ score was 60.7 ± 22.8. Left-side resection and anterior insular resection were performed in 9 patients each. Favorable seizure control (International League Against Epilepsy class 1–3) was achieved in 8 patients. Postoperative motor deficits were observed in 9 patients (permanent in 6, transient in 3). Within-subject changes in DQ/IQ were not significantly affected by insular resection (p = 0.13). Postoperative changes in DQ/IQ were not significantly affected by surgical side, anterior insular resection, AED reduction, or seizure outcome. Only verbal function showed no significant changes before and after surgery and no significant effects of within-subject factors.

CONCLUSIONS

Resection involving the insula in children with impaired development or intelligence can be performed without significant reduction in DQ/IQ, but carries the risk of postoperative motor deficits.

ABBREVIATIONS AED = antiepileptic drug; CST = corticospinal tract; DCS = direct cortical stimulation; DQ = developmental quotient; FCD = focal cortical dysplasia; IED = interictal epileptic discharge; ILAE = International League Against Epilepsy; IQ = intelligence quotient; KIDS = Kinder Infant Development Scale; MEG = magnetoencephalography; SISCOM = subtraction ictal SPECT coregistered to MRI; T-B test = Tanaka-Binet test; WISC = Wechsler Intelligence Scale for Children.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Masaki Iwasaki: National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan. iwa@ncnp.go.jp.

INCLUDE WHEN CITING Published online August 7, 2020; DOI: 10.3171/2020.5.PEDS2058.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Bouthillier A, Nguyen DK. Epilepsy surgeries requiring an operculoinsular cortectomy: operative technique and results. Neurosurgery. 2017;81(4):602612.

    • Search Google Scholar
    • Export Citation
  • 2

    Freri E, Matricardi S, Gozzo F, Perisylvian, including insular, childhood epilepsy: Presurgical workup and surgical outcome. Epilepsia. 2017;58(8):13601369.

    • Search Google Scholar
    • Export Citation
  • 3

    Gras-Combe G, Minotti L, Hoffmann D, Surgery for nontumoral insular epilepsy explored by stereoelectroencephalography. Neurosurgery. 2016;79(4):578588.

    • Search Google Scholar
    • Export Citation
  • 4

    Jobst BC, Gonzalez-Martinez J, Isnard J, The insula and its epilepsies. Epilepsy Curr. 2019;19(1):1121.

  • 5

    Laoprasert P, Ojemann JG, Handler MH. Insular epilepsy surgery. Epilepsia. 2017;58(suppl 1):3545.

  • 6

    Park YS, Lee YH, Shim KW, Insular epilepsy surgery under neuronavigation guidance using depth electrode. Childs Nerv Syst. 2009;25(5):591597.

    • Search Google Scholar
    • Export Citation
  • 7

    von Lehe M, Parpaley Y. Insular cortex surgery for the treatment of refractory epilepsy. J Clin Neurophysiol. 2017;34(4):333339.

  • 8

    von Lehe M, Wellmer J, Urbach H, Insular lesionectomy for refractory epilepsy: management and outcome. Brain. 2009;132(Pt 4):10481056.

    • Search Google Scholar
    • Export Citation
  • 9

    Weil AG, Le NM, Jayakar P, Medically resistant pediatric insular-opercular/perisylvian epilepsy. Part 2: Outcome following resective surgery. J Neurosurg Pediatr. 2016;18(5):523535.

    • Search Google Scholar
    • Export Citation
  • 10

    Ikegaya N, Takahashi A, Kaido T, Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: technical case report. J Neurosurg. 2018;128(4):11731177.

    • Search Google Scholar
    • Export Citation
  • 11

    Kurth F, Zilles K, Fox PT, A link between the systems: functional differentiation and integration within the human insula revealed by meta-analysis. Brain Struct Funct. 2010;214(5-6):519534.

    • Search Google Scholar
    • Export Citation
  • 12

    Nguyen DK, Nguyen DB, Malak R, Revisiting the role of the insula in refractory partial epilepsy. Epilepsia. 2009;50(3):510520.

  • 13

    Afif A, Minotti L, Kahane P, Hoffmann D. Anatomofunctional organization of the insular cortex: a study using intracerebral electrical stimulation in epileptic patients. Epilepsia. 2010;51(11):23052315.

    • Search Google Scholar
    • Export Citation
  • 14

    Gasquoine PG. Contributions of the insula to cognition and emotion. Neuropsychol Rev. 2014;24(2):7787.

  • 15

    Oh A, Duerden EG, Pang EW. The role of the insula in speech and language processing. Brain Lang. 2014;135:96103.

  • 16

    Ibañez A, Gleichgerrcht E, Manes F. Clinical effects of insular damage in humans. Brain Struct Funct. 2010;214(5-6):397410.

  • 17

    Boucher O, Rouleau I, Escudier F, Neuropsychological performance before and after partial or complete insulectomy in patients with epilepsy. Epilepsy Behav. 2015;43:5360.

    • Search Google Scholar
    • Export Citation
  • 18

    Mullatti N, Landre E, Mellerio C, Stereotactic thermocoagulation for insular epilepsy: lessons from successes and failures. Epilepsia. 2019;60(8):15651579.

    • Search Google Scholar
    • Export Citation
  • 19

    Nickels KC, Zaccariello MJ, Hamiwka LD, Wirrell EC. Cognitive and neurodevelopmental comorbidities in paediatric epilepsy. Nat Rev Neurol. 2016;12(8):465476.

    • Search Google Scholar
    • Export Citation
  • 20

    Janszky J, Ebner A, Kruse B, Functional organization of the brain with malformations of cortical development. Ann Neurol. 2003;53(6):759767.

    • Search Google Scholar
    • Export Citation
  • 21

    Fisher RS, Cross JH, French JA, Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522530.

    • Search Google Scholar
    • Export Citation
  • 22

    Honda R, Kaido T, Sugai K, Long-term developmental outcome after early hemispherotomy for hemimegalencephaly in infants with epileptic encephalopathy. Epilepsy Behav. 2013;29(1):3035.

    • Search Google Scholar
    • Export Citation
  • 23

    Boshuisen K, van Schooneveld MM, Uiterwaal CS, Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Ann Neurol. 2015;78(1):104114.

    • Search Google Scholar
    • Export Citation
  • 24

    Baldo JV, Wilkins DP, Ogar J, Role of the precentral gyrus of the insula in complex articulation. Cortex. 2011;47(7):800807.

  • 25

    Holmes GL. What is more harmful, seizures or epileptic EEG abnormalities? Is there any clinical data? Epileptic Disord. 2014;16(Spec No 1):S12S22.

    • Search Google Scholar
    • Export Citation
  • 26

    Korman B, Krsek P, Duchowny M, Early seizure onset and dysplastic lesion extent independently disrupt cognitive networks. Neurology. 2013;81(8):745751.

    • Search Google Scholar
    • Export Citation
  • 27

    Nicolai J, Ebus S, Biemans DP, The cognitive effects of interictal epileptiform EEG discharges and short nonconvulsive epileptic seizures. Epilepsia. 2012;53(6):10511059.

    • Search Google Scholar
    • Export Citation
  • 28

    Whitaker S, Gordon S. Floor effects on the WISC-IV. Int J Dev Disabil. 2012;58(2):111119.

  • 29

    Whitaker S, Wood C. The distribution of scaled scores and possible floor effects on the WISC-III and WAIS-III. J Appl Res Intellect Disabil. 2007;21(2):136141.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 129 129 74
Full Text Views 27 27 25
PDF Downloads 27 27 25
EPUB Downloads 0 0 0