Abstract
Neuropsychology plays an essential role in pediatric epilepsy surgery. Evaluations
provide information to inform presurgical decision-making by addressing localization
and lateralization of deficits and by informing risk of postsurgical decline. The
pediatric neuropsychologist also assists with multiple additional procedures, including
the Wada or Intracarotid amobarbital procedure, functional magnetic resonance imaging,
and brain mapping (on the ward and in the operating room), to measure localization
and lateralization of eloquent cortex as well as adequacy of brain tissue to be resected
and risk of resection of specific cortex. Neuropsychology provides postsurgical outcome
information not only for individual patients, but as “quality control” for epilepsy
surgery. Multiple factors complicate individual patient data interpretation, and these
factors are essential to understand and consider. Developmental considerations are
paramount. Although methodological differences between studies can also make surgical
outcome studies challenging to interpret, neuropsychological data suggest that pediatric
surgery can improve developmental outcomes and trajectories, particularly if resection
is done early and without lengthy presurgical seizure duration, although longer seizure
duration and polypharmacy, more widespread disease, and larger areas of resection,
particularly of critical eloquent cortex, can be costly to the individual patient.
Additional and more refined research is needed.
Keywords
neuropsychology - epilepsy surgery - pediatric psychology - fMRI - Wada
