Brain Advance Access originally published online on April 13, 2005
Brain 2005 128(7):1536-1545; doi:10.1093/brain/awh499
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Epilepsy surgery does not harm motor performance of children and adolescents
1 Department of Paediatric Physical Therapy and Exercise Physiology, 2 Department of Neuropsychology, 3 Department of Paediatric Rehabilitation, 4 Department of General and Special Education, Utrecht University, 5 Department of Child Neurology, University Medical Centre, Wilhelmina Children's Hospital and 6 Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands
Correspondence to: R. van Empelen, NetChild, Department of Paediatric Physical Therapy and Exercise Physiology, University Medical Centre, Wilhelmina Children's Hospital, RM. KB 02.056.0, P.O. Box 85090 3508 AB, Utrecht, The Netherlands. Network for Childhood Disability Research in The Netherlands E-mail: R.vanEmpelen{at}wkz.azu.nl
The impact of epilepsy surgery on motor performance, activities of daily life (ADL) and caregiver assistance was assessed in 37 children (age range 0.1–15.4 years) with pharmacologically untreatable epilepsy, 17 of whom were also diagnosed as having spasticity of cerebral origin. All patients underwent epilepsy surgery between 1996 and 2001 at the Wilhelmina University Children's Hospital and were assessed using a standard protocol at fixed intervals: before surgery and 6 months, 1 year and 2 years after surgery. The type of surgery was hemispherectomy (n = 14) and temporal (n = 14), frontal (n = 4), parietal (n = 2) and central (n = 2) resection. One child underwent callosotomy. Engel's classification was used to determine seizure outcome. Impairments were measured in terms of muscle strength, range of motion and muscle tone. Motor performance of infants and children without spasticity was measured using the Movement Assessment Battery for Children (M-ABC). The Gross Motor Function Measure (GMFM-88) was used in children with spasticity, the severity of motor disability in this group being determined by means of the Gross Motor Function Classification System (GMFCS). Daily activities and caregiver's assistance were measured in all children using the Pediatric Evaluation of Disability Inventory (PEDI). Twenty-four months after surgery 74% of the children could be classified as Engel class 1, indicating a significant seizure reduction. Impairments revealed some decrease in muscle strength and range of motion in the group with spasticity. Scores improved statistically significantly at group level on M-ABC and GMFM (P < 0.05). Improvement in activities of daily life and caregiver's assistance could not be measured in children without spasticity because of the ceiling effect of the PEDI, but children with spasticity improved significantly with respect to these parameters (PEDI) (P < 0.05). Hence, epilepsy surgery does not harm motor performance in children with or without spasticity.
Key Words: epilepsy surgery; children; motor development; GMFCS; activities of daily life (ADL)
Abbreviations: ADL = activities of daily life; GMFCS = Gross Motor Function Classification System; GMFM = Gross Motor Function Measure; ICF = International Classification of Functioning, Disability and Health; M-ABC = Movement Assessment Battery for Children; PEDI = Pediatric Evaluation of Disability Inventory
Received October 11, 2004. Revised March 6, 2005. Accepted March 7, 2005.