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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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u2013III 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 (\n                      <jats:italic>F<\/jats:italic>\n                      \u2009=\u20094.183;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-026-07398-3","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T21:54:58Z","timestamp":1784325298000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond seizures: understanding adaptive functioning in drug-resistant epilepsy in patients undergoing palliative surgery"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0398-5306","authenticated-orcid":false,"given":"Ana Valeria Duarte","family":"Oliveira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1069-7804","authenticated-orcid":false,"given":"H\u00e9lio Rubens","family":"Machado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9157-790X","authenticated-orcid":false,"given":"\u00darsula","family":"Thom\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geisa","family":"de Angelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0558-3519","authenticated-orcid":false,"given":"Jo\u00e3o Pereira","family":"Leite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1884-7264","authenticated-orcid":false,"given":"Ana Paula","family":"Hamad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1768-2357","authenticated-orcid":false,"given":"Am\u00e9rico Ceiki","family":"Sakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7756-8882","authenticated-orcid":false,"given":"Tonicarlo Rodrigues","family":"Velasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"7398_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1684\/epd.2015.0736","volume":"17","author":"P Camfield","year":"2015","unstructured":"Camfield P, Camfield C (2015) Incidence, prevalence and aetiology of seizures and epilepsy in children. 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The Ethics Committee of the Clinical Hospital of the Medicine School of Ribeir\u00e3o Preto of University of S\u00e3o Paulo approved this study (No. 2.167.135\/Date: 11\/07\/2017). We confirm that we have read the journal\u2019s position on issues related to ethical publication and affirm that this report is consistent with those guidelines.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective study was submitted to Research Ethics Committee of the Clinical Hospital of the Medicine School of Ribeir\u00e3o Preto - University of S\u00e3o Paulo (CEP - HCFMRP-USP) and received the approved opinion number: 2.167.135.","order":2,"name":"Ethics","label":"Consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The Research Ethics Committee of the Clinical Hospital of the Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo (CEP-HCFMRP-USP), approved the participants\u2019 informed consent, under approval number 2.167.135.","order":3,"name":"Ethics","label":"Consent to participate and to publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We hereby authorize that the content of the article, including tables, graphs, images, and texts, be made publicly available in accordance with the agreed terms, with proper citation and due respect for authorship rights.","order":5,"name":"Ethics","label":"Disclosure statement","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"300"}}