Neuropsychological Markers of Executive Function in Paediatric Epilepsies and Paediatric Epilepsy Surgery

Abstract

This thesis comprises three papers investigating executive function outcomes in paediatric epilepsies and paediatric epilepsy surgery: a systematic review, an empirical study and a critical appraisal. Within the review, systematic searching techniques were used to identify all available literature exploring functional neuroimaging and neuropsychological functioning related to executive functions in children with epilepsy. Twenty-three publications were identified for inclusion in the review. All studies underwent quality assessment and results were brought together using narrative synthesis, with ongoing recommendations for clinical practice and research discussed thereafter. Overall, studies revealed evidence of disruptions to a fronto-parietal network involved in executive functions. The findings have relevance for understanding key brain regions and networks, and disruption to their development, in paediatric epilepsies. The empirical research project took a network approach to compare fronto-parietal and temporal epilepsies on measures of executive function, including working memory, cognitive flexibility, attention and parented-rated executive function. A longitudinal, multi-centre study was conducted, using Northern Children's Epilepsy Surgery Service (NORCESS) data in children aged 6 years to 17 years 11 months, at pre- (n = 194) and post-surgery (n = 48). At baseline, children with fronto-parietal epilepsies had greater rates of working memory and cognitive flexibility difficulties than children with temporal epilepsy. Following surgery, there was evidence to suggest a stabilising of the development of executive function skills in a fronto-parietal epilepsy group, however at an individual-level outcomes were variable. The findings highlight the need for more research on the individual components of executive function and an agreement on core outcome measures for executive function in the UK. Finally, the critical appraisal included a discussion of the strengths and limitations of the systematic review and empirical study. Reflections on process and contributions to research are discussed, in addition to the clinical implications of the findings.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anja Wittkowski (Supervisor) & Rebecca Bromley (Supervisor)