TY - JOUR
T1 - Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery
AU - Boshuisen, Kim
AU - van Schooneveld, Monique M. J.
AU - Uiterwaal, Cuno S. P. M.
AU - Cross, J. Helen
AU - Harrison, Sue
AU - Polster, Tilman
AU - Daehn, Marion
AU - Djimjadi, Sarina
AU - Yalnizoglu, Dilek
AU - Turanli, Guzide
AU - Sassen, Robert
AU - Hoppe, Christian
AU - Kuczaty, Stefan
AU - Barba, Carmen
AU - Kahane, Philippe
AU - Schubert-Bast, Susanne
AU - Reuner, Gitta
AU - Bast, Thomas
AU - Strobl, Karl
AU - Mayer, Hans
AU - de Saint-Martin, Anne
AU - Seegmuller, Caroline
AU - Laurent, Agathe
AU - Arzimanoglou, Alexis
AU - Braun, Kees P. J.
PY - 2015/7
Y1 - 2015/7
N2 - ObjectiveAntiepileptic drugs (AEDs) have cognitive side effects that, particularly in children, may affect intellectual functioning. With the TimeToStop (TTS) study, we showed that timing of AED withdrawal does not majorly influence long-term seizure outcomes. We now aimed to evaluate the effect of AED withdrawal on postoperative intelligence quotient (IQ), and change in IQ (delta IQ) following pediatric epilepsy surgery.MethodsWe collected IQ scores of children from the TTS cohort with both pre- and postoperative neuropsychological assessments (NPAs; n=301) and analyzed whether reduction of AEDs prior to the latest NPA was related to postoperative IQ and delta IQ, using linear regression analyses. Factors previously identified as independently relating to (delta) IQ, and currently identified predictors of (delta) IQ, were considered possible confounders and used for adjustment. Additionally, we adjusted for a compound propensity score that contained previously identified determinants of timing of AED withdrawal.ResultsMean interval to the latest NPA was 19.818.9 months. Reduction of AEDs at the latest NPA significantly improved postoperative IQ and delta IQ (adjusted regression coefficient [RC]=3.4, 95% confidence interval [CI]=0.6-6.2, p=0.018 and RC=4.5, 95% CI=1.7-7.4, p=0.002), as did complete withdrawal (RC=4.8, 95% CI=1.4-8.3, p=0.006 and RC=5.1, 95% CI=1.5-8.7, p=0.006). AED reduction also predicted 10-point IQ increase (p=0.019). The higher the number of AEDs reduced, the higher was the IQ (gain) after surgery (RC=2.2, 95% CI=0.6-3.7, p=0.007 and RC=2.6, 95% CI=1.0-4.2, p=0.001, IQ points per AED reduced).InterpretationStart of AED withdrawal, number of AEDs reduced, and complete AED withdrawal were associated with improved postoperative IQ scores and gain in IQ, independent of other determinants of cognitive outcome. Ann Neurol 2015;78:104-114
AB - ObjectiveAntiepileptic drugs (AEDs) have cognitive side effects that, particularly in children, may affect intellectual functioning. With the TimeToStop (TTS) study, we showed that timing of AED withdrawal does not majorly influence long-term seizure outcomes. We now aimed to evaluate the effect of AED withdrawal on postoperative intelligence quotient (IQ), and change in IQ (delta IQ) following pediatric epilepsy surgery.MethodsWe collected IQ scores of children from the TTS cohort with both pre- and postoperative neuropsychological assessments (NPAs; n=301) and analyzed whether reduction of AEDs prior to the latest NPA was related to postoperative IQ and delta IQ, using linear regression analyses. Factors previously identified as independently relating to (delta) IQ, and currently identified predictors of (delta) IQ, were considered possible confounders and used for adjustment. Additionally, we adjusted for a compound propensity score that contained previously identified determinants of timing of AED withdrawal.ResultsMean interval to the latest NPA was 19.818.9 months. Reduction of AEDs at the latest NPA significantly improved postoperative IQ and delta IQ (adjusted regression coefficient [RC]=3.4, 95% confidence interval [CI]=0.6-6.2, p=0.018 and RC=4.5, 95% CI=1.7-7.4, p=0.002), as did complete withdrawal (RC=4.8, 95% CI=1.4-8.3, p=0.006 and RC=5.1, 95% CI=1.5-8.7, p=0.006). AED reduction also predicted 10-point IQ increase (p=0.019). The higher the number of AEDs reduced, the higher was the IQ (gain) after surgery (RC=2.2, 95% CI=0.6-3.7, p=0.007 and RC=2.6, 95% CI=1.0-4.2, p=0.001, IQ points per AED reduced).InterpretationStart of AED withdrawal, number of AEDs reduced, and complete AED withdrawal were associated with improved postoperative IQ scores and gain in IQ, independent of other determinants of cognitive outcome. Ann Neurol 2015;78:104-114
KW - DOUBLE-BLIND
KW - CHILDREN
KW - CHILDHOOD
KW - MONOTHERAPY
KW - OUTCOMES
KW - SPEED
KW - TIME
UR - http://www.scopus.com/inward/record.url?scp=84932630491&partnerID=8YFLogxK
U2 - 10.1002/ana.24427
DO - 10.1002/ana.24427
M3 - Article
C2 - 25899932
SN - 0364-5134
VL - 78
SP - 104
EP - 114
JO - Annals of Neurology
JF - Annals of Neurology
IS - 1
ER -