Epilepsy surgery in children with drug-resistant epilepsy, a long-term follow-up.

OBJECTIVES: In this follow-up study, we wanted to present the long-term outcome (5-21 years) in terms of seizure freedom, seizure reduction, and the cognitive development in the first 47 children who underwent epilepsy surgery at the University Hospital in Lund from 1991 to 2007. MATERIALS AND METHODS: All children who underwent epilepsy surgery in the southern region of Sweden were assessed for cognitive function before surgery and at follow-up. A review of medical documents for demographic data and seizure-related characteristics was made by retrospectively examining the clinical records. RESULTS: Forty-seven children with a median age at surgery of 8 years (range 0.5-18.7 years) were included. Twenty-three children achieved seizure freedom, six demonstrated >75% improvement in seizure frequency, and none of the children experienced an increase in seizure frequency. Twenty-one children required a reoperation to achieve satisfactory seizure outcomes. Cognitive functional level was preserved, and the majority of patients, 34 (76%), followed their expected cognitive trajectory. The patients who became seizure free significantly improved their cognitive processing speed, even after long-term follow-up. CONCLUSIONS: Epilepsy surgery in children offers suitable candidates a good chance of significantly improved outcome and low rates of complications. Several children, however, required a reoperation to achieve satisfactory seizure outcomes. Cognitive level was preserved, and the majority of patients followed their expected cognitive trajectory. Cognitive improvements in processing speed appear to occur in parallel with seizure control and were even more pronounced in subjects with no anti-epilepsy drugs. These improvements persisted even after long-term follow-up.

Anger, depression and anxiety associated with endothelial function in childhood and adolescence.

OBJECTIVE: Psychosocial adversity is a risk factor for cardiovascular disease (CVD) in adults. The authors assessed associations of reactive hyperaemia peripheral arterial tonometry (RH-PAT), a measure of endothelial function predictive of CVD, with self-assessed psychological health among school children. METHODS: A total of 248 healthy school children (mean (SD) age 14.0 (1.0); 136 girls and 112 boys) underwent RH-PAT testing. They completed the Beck Youth Inventories (BYI) of emotional and social impairment scales, which is used to screen for depression, anxiety, anger and disruptive behaviour. RESULTS: No sex differences were observed for the RH-PAT score. Statistically significant differences were observed for the BYI scores; girls had higher scores for depression, anger and anxiety. Among the girls, there were statistically significant associations between lower RH-PAT scores and higher scores for anger (B coefficient=-0.100, p=0.040), depression (-0.108, p=0.009) and anxiety (-0.138, p=0.039) after adjustment for age. Among the boys, disruptive behaviour was associated with higher RH-PAT scores (0.09, p=0.006). CONCLUSIONS: The girls have higher levels of self-assessed anger; depression and anxiety compared with the boys, and these characteristics are associated with lower RH-PAT scores, indicating attenuated endothelial function. Among the boys, disruptive behaviour was associated with better endothelial function. Although psychological ill-health is associated with impaired endothelial function and CVD among adults, such processes may also be relevant to children. Psychosocial adversity in childhood might be a risk factor for subsequent CVD.

Cognitive function in young adults following intrauterine growth restriction with abnormal fetal aortic blood flow.

OBJECTIVE: Intrauterine growth restriction (IUGR) is a recognized risk factor for neurological deficits later in life. Abnormal fetal blood flow in the presence of IUGR helps to distinguish fetuses with true growth impairment from those that are small but normally grown. This study aimed to evaluate the influence of IUGR with abnormal fetal blood flow on cognitive function and psychological development in young adults. METHODS: Cognitive capacity (Wechsler adult intelligence scale-III (WAIS-III)) and psychological development (symptom check-list and Wender Utah rating scale) were evaluated at 18 years of age in 19 subjects who had had IUGR (abnormal fetal blood flow in the descending aorta and birth weight small-for-gestational age) and in 23 control subjects who had had normal fetal aortic blood flow and birth weight appropriate-for-gestational age (AGA). School grades at 16 years of age were also recorded. RESULTS: The IUGR subjects had significantly lower results at 18 years of age in the combined subtests of the WAIS-III measuring executive cognitive functions (P = 0.03) and lower school grades at 16 years of age (P = 0.03) compared with the AGA group. IUGR subjects did not exhibit significantly more psychological distress symptoms. CONCLUSION: IUGR with abnormal fetal blood flow is associated with impaired executive cognitive function in young adults.

Longitudinal follow-up of children born preterm: somatic and mental health, self-esteem and quality of life at age 19.

In a long-term prospective study, 39 preterm children born before 35 completed weeks of gestation and 23 full-term children were followed up at 19 years of age. Information about somatic and mental health was obtained through interviews and confirmed by medical records. Self-esteem and quality of life were assessed from the subjects' perspective. Significantly more preterms than full-terms had somatic health problems, both during childhood and adolescence and also at age 19. A wide spectrum of diagnoses was represented. Preterms with moderately severe somatic problems also showed signs of psychological distress. The frequency of mental health problems did not differ between the groups. Preterms and full-terms had similarly positive scores regarding self-esteem and quality of life. Altogether, the results indicate that apart from some vulnerability regarding physical health, this group of moderately immature subjects born preterm seems to function as well as young adults in general in important domains of life.

Longitudinal follow-up of children born preterm: cognitive development at age 19.

In a long-term prospective study, 39 preterm children born before 35 completed weeks of gestation and 23 full-term children were followed up at 4, 9 and 19 years of age. Psychometric evaluation of the cognitive development at 4 years of age showed that the preterms fell within the normal range, although their performance was inferior to that of the full-terms. This difference between the groups was not found at 9 and 19 years of age. Within the preterm group there was no correlation between the test results and birthweight, gestational age, prenatal or perinatal optimality scores. Full-terms had better scholastic performance at the end of compulsory schooling, while there was no difference at 19 years of age. At 19 years of age, about 1/3 of the children in both groups rated themselves as having had attention deficits during their childhood and adolescence. In this group of moderately immature, low-risk children, preterm birth without major physical or mental disabilities poses a developmental risk that seems to have the greatest impact during the preschool years and then gradually attenuates.

Abnormal fetal aortic velocity waveform and intellectual function at 7 years of age.

Measurements of fetal aortic blood flow velocity and fetal growth were performed in 178 pregnancies. In 87 cases, the estimated fetal weight was > 2 SD below the gestational age-related mean of the population. Three fetuses died in utero. In 148 children (84%) an assessment of overall intellectual ability was performed at 6.5 years of age. Verbal and global IQ was lower in the group with an abnormal fetal aortic blood flow velocity waveform (mean +/- SD 96.0 +/- 17.7 and 95.9 +/- 15.7, respectively; n = 41) compared to the group with a normal waveform (102.1 +/- 12.2 and 102.9 +/- 13.2, respectively; n = 105; p < 0.05). Logistic regression analysis revealed that abnormal fetal aortic velocity waveform, both independently and in combination with other factors, was a significant predictor of impaired intellectual outcome. The association found between abnormal fetal aortic velocity waveform and impaired intellectual outcome suggests that hemodynamic evaluation of the fetus has a predictive value regarding postnatal intellectual development.