Comparison of Surgical Techniques in Children with Autism Spectrum Disorder and Refractory Epilepsy: Efficacy and Cognitive Outcomes

Introduction: Refractory epilepsy is common in children with Autism Spectrum Disorder (ASD), significantly affecting their cognitive development and quality of life. Surgical interventions provide a therapeutic option, but it remains unclear which technique offers the best outcomes for this population. Objective: To compare the efficacy and safety of four surgical techniques—lesionectomy, temporal lobectomy, extratemporal cortical resection, and functional hemispherectomy—in children with refractory epilepsy, both with and without ASD, and evaluate their impact on cognitive and behavioral development and quality of life. Methodology: A retrospective study was conducted with 120 children diagnosed with refractory epilepsy, equally divided between those with and without ASD. Patients were assigned to one of four surgical groups (n = 15 per group) based on the intervention performed. Data on demographic and clinical characteristics, as well as one-year postoperative outcomes—including seizure control (Engel classification), intelligence quotient (WISC-V), adaptive behavior (Vineland-II), and quality of life (PedsQL)—were collected. Statistical analyses were applied to compare the results among groups, and logistic regression was used to identify the predictors of seizure freedom. Results: Lesionectomy and temporal lobectomy groups showed significantly higher rates of seizure freedom (80% and 73%, respectively) compared to extratemporal resection (60%) and functional hemispherectomy (67%). These groups also presented significant improvements in intelligence quotient, adaptive behavior, quality of life, and reductions in ASD symptoms (p < 0.01). Perioperative complications were notably lower in the lesionectomy and temporal lobectomy groups (7%) compared to extratemporal resection and functional hemispherectomy (40%; p = 0.007). Significant predictors of seizure freedom included the presence of structural anomalies on neuroimaging and a shorter duration of epilepsy before surgery (p < 0.05). Conclusions: Lesionectomy and temporal lobectomy are highly effective and safer surgical techniques for managing refractory epilepsy in children with ASD, providing significant benefits in seizure control, cognitive development, and quality of life. Importantly, the outcomes observed are not exclusive to children with ASD but likely reflect broader efficacy across pediatric epilepsy populations. The early identification of surgical candidates and comprehensive preoperative evaluations are essential for optimizing outcomes, emphasizing the importance of individualized treatment planning and further comparative research to validate these findings.