Neuropsychology of childhood epilepsy: pre- and postsurgical assessment

Childhood epilepsy is one of the most prevalent forms of chronic and disabl ing childhood disorders. Because it disrupts brain maturation, it has long been thought to produce non-specific consequences such as mental deficiency and behavioral problems. However, advances in medical knowledge have shown that childhood epilepsy should not be considered as a single disorder, and it is now becoming apparent that various clinical entities have different cognitive expressions that yet need to be specified. The purpose of this pa per is to provide an up-to-date analysis of this multi-faceted pathology. T he first section is devoted to the characterization of the neuropsychologic al profile that accompanies focal epilepsies, as defined by the site of the epileptic process. We report the first group study of children with fronta l robe epilepsy. The results indicate that frontal lobe epilepsy produces s ymptoms (deficits of planning, attention and motor dexterity) that are akin to those found in frontal-lesioned adults. Similarly, like in adults, temp oral lobe epilepsy produces memory impairment in children as well as behavi oral and academic disturbances. Occipito-parietal lobe epilepsy is rare in children and its effects still need to be specified. The second section dea ls with the neuropsychological techniques used in presurgical evaluation. F inally, the various neurosurgical procedures that are increasingly being us ed as part of the arsenal of epilepsy treatment are described along with th e neuropsychological findings that are associated with these interventions. It can be concluded that the beneficial effects of epilepsy surgery (callo sotomy, hemispherectomy, temporal and extra-temporal resections) by far out weigh the few cognitive deficits that are occasionally reported following t hese interventions.