Prentice, Freya; (2025) Language plasticity and cognition in children undergoing epilepsy surgery. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Language and verbal memory difficulties are common in children with epilepsy and after epilepsy surgery. Children with epilepsy also demonstrate higher rates of atypical language lateralisation compared to the general population. In adults, the side, site and extent of resection and preoperative language lateralisation are predictors of postoperative language and verbal memory decline. However, evidence in children is inconclusive. This thesis had two main aims: (1) To investigate the effect of epilepsy on language lateralisation and evaluate models of plasticity. (2) To characterise preoperative and postoperative language and verbal memory performance and identify predictors of postoperative decline in children undergoing epilepsy surgery. To address the first aim, I collated a large multi-centre dataset of 1254 individuals with focal epilepsy and fMRI language lateralisation. I examined predictors of atypical language lateralisation from a theoretical and clinical perspective. To address the second aim, I examined language and memory profiles before and after surgery in children with focal epilepsy and used logistic regression models to predict postoperative decline. Predictors included those based on adult neuropsychology models emphasising the side, site and extent of resection and language lateralisation, and more developmentally informed variables, such as age at seizure onset and surgery. I found an exponential decline in language reorganisation with increasing age at seizure onset, supporting the ‘sensitive period’ model of plasticity. I identified robust clinical predictors of atypical language lateralisation and developed a ‘cumulative predictor score’. Verbal cognition was vulnerable before and after surgery. There was an overall absence of lesion-specific cognitive impairments, with the only robust structure-function relationship being between hippocampal resection and word pair decline. Preoperative abilities and age at surgery were the most consistently identified predictor of decline, with the laber supporting the ‘early plasticity’ model of development.

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