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Clinical factors such as seizure cessation or antiepileptic medication discontinuation have been implicated, but do not fully account for the heterogeneity seen. Less is known about the impact of neurobiological factors, such as brain development and resection location. This study examines clinical and neuroimaging factors associated with cognitive outcome after epilepsy surgery in childhood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010two children (28 boys, 24 girls) were evaluated for epilepsy surgery and reassessed on average 7.7\u00a0years later. In the intervening time, 13 were treated pharmacologically and 39 underwent focal surgery (17 temporal, 16 extratemporal, six multilobar; mean age at surgery = 14.0\u00a0years). Pre\u2010 and postsurgical assessments included <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> tests and T1\u2010weighted brain images. Predictors of <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> change were investigated, including voxel\u2010based analyses of resection location, and gray and white matter volume change.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall modest <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> improvement was seen in children treated surgically, but not in those treated pharmacologically only. Applying a \u226510\u2010point change threshold, 39% of the surgically treated children improved, whereas 10% declined. Clinical factors associated with <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> increases were lower preoperative <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> and longer follow\u2010up duration, whereas seizure and antiepileptic medication cessation were not predictive. Among neuroimaging factors, we observed that left anterior temporal resections impacted negatively on verbal reasoning, linked to full\u2010scale <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> decline. In contrast, gray matter volume change in ipsi\u2010 and contralesional hemispheres was positively correlated with <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> change. Voxel\u2010based morphometry identified the gray matter volume change in the contralesional dorsolateral frontal cortex as most strongly associated with <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content> improvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>We show that a variety of factors are likely to contribute to patterns of postsurgical change in <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content>. Neuroimaging results indicate that left anterior temporal resections constrain development of verbal cognition, whereas simultaneously cortical growth after surgical treatment can support improvements in <jats:styled-content style=\"fixed-case\">IQ<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.14707","type":"journal-article","created":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T11:31:53Z","timestamp":1554895913000},"page":"872-884","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case\u2010control neuroimaging study"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-7787","authenticated-orcid":false,"given":"Caroline","family":"Skirrow","sequence":"first","affiliation":[{"name":"Developmental Neurosciences Programme Great Ormond Street Institute of Child Health, University College London  London UK"},{"name":"Department of Neuropsychology Great Ormond Street Hospital for Children NHS Foundation Trust  London UK"},{"name":"Cambridge Cognition  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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