Beyond seizures: understanding adaptive functioning in drug-resistant epilepsy in patients undergoing palliative surgery

PURPOSE: To evaluate clinical predictors of adaptive functioning in pediatric patients with drug-resistant epilepsy (DRE) and the impact of corpus callosotomy and vagus nerve stimulation (VNS) using the Vineland Adaptive Behavior Scales (VABS) during long-term follow-up. METHODS: This retrospective observational cohort study included 37 pediatric patients with DRE who underwent callosotomy (n = 24) or VNS (n = 13) at the Ribeirão Preto Epilepsy Surgery Program, University of São Paulo, between 2007 and 2018. Adaptive functioning was assessed using the VABS at three time points: preoperative, postoperative I (mean 25 months), and postoperative II (mean 51 months). Seizure outcomes were classified according to the Engel scale. Statistical analyses included analysis of variance, Pearson correlation, linear regression, and a general linear model for repeated measures. RESULTS: All patients presented adaptive delay preoperatively, with discrepancies between chronological age and age-equivalent scores. Postoperatively, seizure reduction occurred in 70.2% of patients, with most achieving Engel class II-III outcomes. A reduction in antiseizure medication use was observed in 43.2% of patients. Adaptive functioning declined at the first postoperative assessment but gradually improved over time, particularly among patients with better seizure control. Statistical analyses demonstrated significant effects of postoperative time and seizure outcomes on adaptive functioning, with greater improvements in patients with favorable seizure control (F = 4.183; p = 0.024). SIGNIFICANCE: Palliative surgical procedures for pediatric DRE are safe and associated with seizure reduction, decreased medication burden, and gradual improvement in adaptive functioning. Early surgical intervention may help minimize developmental decline and improve long-term adaptive outcomes.