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Seizure outcome after resective epilepsy surgery in patients with low IQ.

Journal article
Authors Kristina Malmgren
Ingrid Olsson
Elisabeth Engman
Roland Flink
Bertil Rydenhag
Published in Brain : a journal of neurology
Volume 131
Issue Pt 2
Pages 535-42
ISSN 1460-2156
Publication year 2008
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Institute of Clinical Sciences
Pages 535-42
Language en
Keywords Adolescent, Adult, Age of Onset, Child, Child, Preschool, Epidemiologic Methods, Epilepsies, Partial, pathology, psychology, surgery, Female, Humans, Infant, Infant, Newborn, Intelligence, Intelligence Tests, Learning Disorders, complications, Male, Mental Retardation, complications, Middle Aged, Postoperative Complications, Prognosis, Treatment Outcome
Subject categories Medical and Health Sciences


Epilepsy surgery has been questioned for patients with low IQ, since a low cognitive level is taken to indicate a widespread disturbance of cerebral function with unsatisfactory prognosis following resective surgery. The prevalence of epilepsy in patients with cognitive dysfunction is, however, higher than in the general population and the epilepsy is often more severe and difficult to treat. It is therefore important to try to clarify whether IQ predicts seizure outcome after resective epilepsy surgery. The Swedish National Epilepsy Surgery Register, which includes data on all epilepsy surgery procedures in Sweden since 1990, was analysed for all resective procedures performed 1990-99. Sustained seizure freedom with or without aura at the 2-year follow-up was analysed as a function of pre-operative IQ level categorized as IQ <50, IQ 50-69 and IQ >or=70 and was also adjusted for the following variables: age at epilepsy onset, age at surgery, pre-operative seizure frequency, pre-operative neurological impairment, resection type and histopathological diagnosis. Four hundred and forty-eight patients underwent resective epilepsy surgery in Sweden from 1990 to 1999 and completed the 2-year follow-up: 72 (16%) had IQ <70, (18 with IQ <50 and 54 with IQ 50-69) and 376 IQ >or=70. There were 313 adults and 135 children or=70 group. There was a significant relation between IQ category and seizure freedom [odds ratio (OR) 0.41, 95% confidence interval (CI) 0.27-0.62] and this held also when adjusting for clinical variables [OR 0.58 (95% CI 0.35-0.95)]. In this population-based epilepsy surgery series, IQ level was shown to be an independent predictor of seizure freedom at the 2-year follow-up. However, many of the low-IQ patients benefit from surgery, especially patients with lesions. Low IQ should not exclude patients from resective epilepsy surgery, but is an important prognostic factor to consider in the counselling process.

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