Long-term outcomes of children with drug-resistant epilepsy across multiple cognitive domains

Aim To simultaneously evaluate long-term outcomes of children with drug-resistant epilepsy (DRE) across multiple cognitive domains and compare the characteristics of participants sharing a similar cognitive profile. Method Participants were adolescents and young adults (AYAs) diagnosed with DRE in childhood, who completed a comprehensive neuropsychological battery evaluating intelligence, memory, academic, and language skills at the time of surgical candidacy evaluation and at long-term follow-up (4-11y later). Hierarchical k-means clustering identified subgroups of AYAs showing a unique pattern of cognitive functioning in the long-term. Results Participants (n=93; mean age 20y 1mo [standard deviation {SD} 4y 6mo]; 36% male) were followed for 7 years (SD 2y 4mo), of whom 65% had undergone resective epilepsy surgery. Two subgroups with unique patterns of cognitive functioning were identified, which could be broadly categorized as 'impaired cognition' (45% of the sample) and 'average cognition' (55% of the sample); the mean z-score across cognitive measures at follow-up was -1.86 (SD 0.62) and -0.23 (SD 0.54) respectively. Surgical and non-surgical patients were similar with respect to seizure control and their long-term cognitive profile. AYAs in the average cognition cluster were more likely to have better cognition at baseline, an older age at epilepsy onset, and better seizure control at follow-up. Interpretation The underlying abnormal neural substrate and seizure control were largely associated with long-term outcomes across cognitive domains.

Automated summary

The study evaluated long-term cognitive outcomes in children with drug-resistant epilepsy, identifying two subgroups with unique patterns of cognitive functioning: impaired cognition and average cognition. Surgical and non-surgical patients showed similar cognitive profiles and seizure control, with those in the average cognition cluster having better cognition at baseline. The underlying neural substrate and seizure control were key factors associated with long-term cognitive outcomes.