LM201 - Central Auditory Processing Evaluation After Pediatric Epilepsy Surgery and the PESA

Abstract:
The Pediatric Epilepsy Surgery Alliance (PESA) is a nonprofit organization that serves the community of children who need temporal lobectomy (TL) or hemispherectomy (HS) to treat their seizures. PESA is interested in the auditory evaluation and rehabilitation of children that have undergone these surgeries. Most of these children rarely undergo central auditory evaluation even though their auditory symptoms are common and often compromise communication, education, and quality of life. Key to this presentation is to increase awareness of the audiological need of these children. Profiled will be auditory symptoms, central auditory test findings. Clinical and habilitative approaches post TL and HS.

Summary:
In pediatric epilepsy surgeries involving the temporal lobe, including temporal lobectomy (TL), hemisphere (HS), the auditory cortex is removed or disconnected on one side. This of course has functional consequences many of which remain unknown. Because the temporal lobe is where Heschl’s gyrus and planum temporal reside higher auditory processes are going to be compromised. This neuroanatomy will be shown and discussed.

Interestingly, when surgery is performed early in life deficits in audition are at times not as devastating as one might expect though variability across patients is high. Plasticity of the intact auditory cortex seems to offset some of the deficits in processing, but many problems often remain. Defining these problems as well as the processes left intact become critical in the evaluation and habilitation of these patients and will be profiled.

Based on some early reports and from a positive perspective, these patients’ ability to detect pure tones at normal levels seems essentially unaffected by removal of one auditory cortex. Unfortunately, this finding has resulted in some medical professionals to believe that overall hearing is unaffected by TL, HS, or TPO —which simply not the case. As mentioned earlier, these children struggle in many listening situations.

Though there is a paucity of studies, it is clear that post surgery these children reveal deficits on tests of central auditory function such as dichotic listening, sound localization, and low redundancy speech tasks. This data, as well as habilitative studies, will be carefully reviewed and will reveal a striking lack of audiology involvement.

With the prevalence of TL, HS, and TPO increasing, audiologists are needed and are encouraged to become involved. With increased diagnostic and habilitative research and clinical awareness, a more complete picture of the auditory abilities and deficits of this interesting and overlooked population will be realized.

The Pediatric Epilepsy Surgery Alliance is a unique caregiver-led, science-driven advocacy organization that draws upon firsthand experience of the pediatric epilepsy surgery journey. Their programs include a parent-proxy patient registry, collecting valuable data on developmental progress, post-operative symptoms, and comorbidities, providing crucial insights into the long-term outcomes of pediatric epilepsy surgery. Audiological involvement with this organization can provide an intriguing clinical research experience as well as providing much needed help to a unique population.

Brief Summary of Clinical Takeaways:
Attendees will gain information on the evaluation & habilitation of children and adults that have undergone temporal lobectomy/hemispherectomy for control of seizures. This will be achieved within a framework of a growing need of audiological involvement for this interesting population spearheaded by the Pediatric Epilepsy Surgical Alliance (PESA).