Original article Surgery of children with frontal lobe lesional epilepsy: Neuropsychological study Daniela Chieffo a , Donatella Lettori a , Ilaria Contaldo a , Francesca Perrino a , Alessandra Graziano a , Concetta Palermo a , Antonio Mittica a , Giampiero Tamburrini b , Domenica Battaglia a , Concezio Di Rocco b , Francesco Guzzetta a,⇑ a Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy b Child Neurosurgery Unit, Catholic University, Rome, Italy Received 21 March 2010; received in revised form 7 June 2010; accepted 8 June 2010 Abstract Aim of the study was to provide new data about the evolution of neuropsychological findings in patients with lesional frontal lobe epilepsy (FLE) operated on with lesion excision. Patients and methods Twelve patients with lesional FLE underwent full clinical examination including neurological, neuropsychological and developmental assessments, high-resolution magnetic resonance imag- ing (MRI), ictal and interictal prolonged EEG monitoring and evaluation of seizure semeiology before and after surgery. The mean follow-up duration was 2 years and 10 months (range = 14 months–7 years). Another group of lesional temporal lobe epilepsy, matched for the age at surgery and side of surgery, was likewise studied in order to compare neuropsychological patterns and to try to find out specific features in frontal lobe epilepsy evolution. Results All patients resulted seizure free at outcome except one belonging to Engel’s class II. Before surgery general intelligence was similar in FLE as well as in TLE group. Executive functions and motor coordination were frequently affected in FLE whereas patients with TLE often presented with deficits in naming, visual memory and visuo-spatial attention. After surgery there was a frequent decline of IQ in FLE group together with a slight deterio- ration, especially of executive functions in some patients. An improvement of behaviour was often observed in both groups. Con- clusions As already reported in literature, neuropsychological pre-surgical data confirms the involvement of attention and executive functions in lesional FLE. No significant neuropsychological improvement was produced by surgery that determined in some cases a slight decline of general intelligence and specific frontal abilities. Yet, generally behaviour improved and seizures were controlled. Ó 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved. Keywords: Frontal epilepsy; Epilepsy surgery; Child neurodevelopment 1. Introduction Frontal lobe (FL) includes different anatomical areas accounting for several complex functions going from the motor to the higher cognitive competences. That is the cause of the known protean disorders that may arise from its injuries. However, it may be frequently hard to establish a direct relationship between injury site and kind of disorder due to the complex organization of this lobe. Several neuropsychological studies are available con- cerning frontal lobe epilepsies (FLE) in children [1–9], when development is particularly florid with variable emergence times of frontal functions [10]. Morphologi- cal studies showed, in fact, that frontal lobes maturation occurs late in adolescence [11,12]. So, patterns of func- tions and quality of dysfunctions may largely vary with 0387-7604/$ - see front matter Ó 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.braindev.2010.06.006 * Corresponding author. Address: Child Neurology and Psychiatry Unit, Catholic University, Largo Gemelli 8, 00168 Rome, Italy. Fax: +39 066893079. E-mail address: fguzzetta@rm.unicatt.it (F. Guzzetta). www.elsevier.com/locate/braindev Brain & Development 33 (2011) 310–315