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Resective Surgery for Patients with Epilepsy and Intellectual Disabilities

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Epilepsy and Intellectual Disabilities

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Abstract

Epilepsy is more prevalent in patients with intellectual disabilities (ID), and is often refractory to medical treatment. However, despite this being a group which could potentially significantly benefit from epilepsy surgery, it is a traditionally held belief that a low IQ is a relative contraindication to surgery. The ID may represent a diffuse cerebral dysfunction with multiple seizure foci, and patients with ID may have limited cognitive reserve and so be at risk of more adverse effects from surgery. Several studies are described which provide evidence that a low IQ in itself should not be an exclusion criteria for surgery, with a good outcome in many.

If surgery is to be considered in patients with ID, then the presurgical evaluation needs to be tailored to the individual. The neuropsychological assessment should take particular care in evaluating expectations from surgery and potential impact on psychosocial functioning, and take into consideration that the tools which we have available are not specific to individuals with ID. Other aspects of the process may be more difficult for patients with ID to tolerate, especially seizure recordings. However, many individuals with ID and refractory epilepsy will have surgically treatable lesions such as benign tumors (DNT, ganglioglioma) and focal cortical dysplasia. Although tuberous sclerosis (TSC) typically has multiple potential seizure foci, in some patients respective surgery can be considered if a single seizure focus can be identified. The complex process involved in the evaluation of patients with TSC is discussed. Some investigation techniques utilized in more complex cases of epilepsy surgery are discussed.

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Authors and Affiliations

  1. Walton Centre NHS Foundation Trust, Liverpool, UK

    B. Ziso MBCHB, MRCP

  2. Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK

    A. Nicolson MB, ChB, FRCP, MD

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  1. B. Ziso MBCHB, MRCP
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  1. NHS Trust, Birmingham Community Healthcare NHS Trust, Birmingham, United Kingdom

    Vee P. Prasher

  2. Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, United Kingdom

    Mike Kerr

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Ziso, B., Nicolson, A. (2016). Resective Surgery for Patients with Epilepsy and Intellectual Disabilities. In: Prasher, V., Kerr, M. (eds) Epilepsy and Intellectual Disabilities. Springer, Cham. https://doi.org/10.1007/978-3-319-39144-1_9

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