Abstract：
In addition to the primary aim of seizure freedom, a key secondary aim of pediatric epilepsy surgery is to stabilize and, potentially, optimize cognitive development. Although the efficacy of surgical treatment for seizure control has been established, the long-term intellectual and developmental trajectories are yet to be delineated. We conducted a systematic review and meta-analysis of studies reporting pre- and postsurgical intelligence or developmental quotients (IQ/DQ) of children with focal lesional epilepsy aged ≤18 years at epilepsy surgery and assessed at >2 years after surgery. We determined the IQ/DQ change and conducted a random-effects meta-analysis and meta-regression to assess its determinants. We included 15 studies reporting on 341 patients. The weighted mean age at surgery was 7.1 years (range = .3-13.8). The weighted mean postsurgical follow-up duration was 5.6 years (range = 2.7-12.8). The overall estimate of the mean presurgical IQ/DQ was 60 (95% confidence interval [CI] = 47-73), the postsurgical IQ/DQ was 61 (95% CI = 48-73), and the change was +.94 IQ/DQ (95% CI = -1.70 to 3.58, p = .486). Children with presurgical IQ/DQ ≥ 70 showed a tendency for higher gains than those with presurgical IQ/DQ < 70 (p = .059). Higher gains were determined by cessation of antiseizure medication (ASM; p = .041), not just seizure freedom. Our findings indicate, on average, stabilization of intellectual and developmental functioning at long-term follow-up after epilepsy surgery. Once seizure freedom has been achieved, ASM cessation enables the optimization of intellectual and developmental trajectories in affected children.
摘要：
目标：除了癫痫发作自由的主要目标之外，小儿癫痫手术的一个关键次要目标是稳定和，潜在的,优化认知发展。虽然已经确定了控制癫痫发作的手术治疗的功效，长期的智力和发展轨迹尚未划定。
方法：我们对研究进行了系统评价和荟萃分析，这些研究报告了癫痫手术中年龄≤18岁的局灶性病灶性癫痫患儿的手术前后智力或发育商（IQ/DQ），并在手术后>2年进行了评估。我们确定了IQ/DQ变化，并进行了随机效应荟萃分析和荟萃回归以评估其决定因素。
结果：我们纳入了15项研究报告341例患者。手术时的加权平均年龄为7.1岁（范围为0.3-13.8）。术后随访时间加权平均为5.6年（范围2.7-12.8）。术前平均IQ/DQ的总体估计值为60（95％CI47-73），术后IQ/DQ为61（95%CI48-73），变化为+0.94IQ/DQ(95%CI-1.70-3.58；p=0.486)。术前IQ/DQ≥70的儿童比术前IQ/DQ<70的儿童表现出更高的增益趋势（p=0.059）。停止抗癫痫药物（ASM；p=0.041）确定了更高的增益，不仅仅是癫痫的自由。
结论：我们的研究结果表明，平均而言,癫痫手术后长期随访时智力和发育功能的稳定。一旦获得了扣押自由，停止ASM可以优化受影响儿童的智力和发育轨迹。本文受版权保护。保留所有权利。
方法：我们对研究进行了系统评价和荟萃分析，这些研究报告了癫痫手术中年龄≤18岁的局灶性病灶性癫痫患儿的手术前后智力或发育商（IQ/DQ），并在手术后>2年进行了评估。我们确定了IQ/DQ变化，并进行了随机效应荟萃分析和荟萃回归以评估其决定因素。
结果：我们纳入了15项研究报告341例患者。手术时的加权平均年龄为7.1岁（范围为0.3-13.8）。术后随访时间加权平均为5.6年（范围2.7-12.8）。术前平均IQ/DQ的总体估计值为60（95％CI47-73），术后IQ/DQ为61（95%CI48-73），变化为+0.94IQ/DQ(95%CI-1.70-3.58；p=0.486)。术前IQ/DQ≥70的儿童比术前IQ/DQ<70的儿童表现出更高的增益趋势（p=0.059）。停止抗癫痫药物（ASM；p=0.041）确定了更高的增益，不仅仅是癫痫的自由。
结论：我们的研究结果表明，平均而言,癫痫手术后长期随访时智力和发育功能的稳定。一旦获得了扣押自由，停止ASM可以优化受影响儿童的智力和发育轨迹。本文受版权保护。保留所有权利。
