Neuropsychological outcomes following paediatric temporal lobe surgery for epilepsy: evidence from a systematic review

The objective of this thesis was to present evidence from a systematic review of the literature to assess wider neuropsychological outcomes for temporal lobe resections for epilepsy in children. Neuropsychological outcome domains included intellectual, memory, language, quality of life, psychological wellbeing, educational, vocational, social and behavioural outcome. A systematic literature search was conducted firstly for all studies reporting any outcomes of any resective paediatric epilepsy surgery, yielding 8189, of which 1259 met criteria. After a brief exploration of these broader epilepsy surgery studies, more focussed eligibility criteria were applied. The final review included only those 73 studies that reported neuropsychological outcome of paediatric temporal lobe surgery for epilepsy. Core findings of the review were that for each neuropsychological outcome domain, the majority of participants remained stable after surgery; some declined and some improved. There was some evidence for increased material-specific memory deficits after temporal lobe surgery based on resection side, and more positive cognitive outcome for those with lower pre-surgical ability level. No quantitative analysis of the factors predicting neuropsychological outcome could be performed due to limitations in methodological and reporting quality of the included studies. However, it is this appraisal of the evidence that is of most interest, as it highlights the need for changes in methodology and reporting. Appropriately designed prospective multicentre trials should be conducted, with adequate follow-up for long-term outcomes to be measured. Surgical centres should continue to publish routine clinical case series, but ensure that they report individual participant data, according to established reporting standards. Core outcome measures should be agreed between centres and researchers should collaborate by making their data available for open reviews, in order to build a higher quality evidence base, so that clinicians, young people and their families can make better informed decisions about whether or not to proceed with surgery.