Long-term outcomes of behavior problems after epilepsy surgery in childhood
- 439 Downloads
Although over 50 % of youth with intractable epilepsy present with behavioral problems, the long-term prognosis after resective epilepsy surgery in childhood is unclear. This study evaluated such outcomes in a cohort of surgical and nonsurgical patients. Participants were 108 patients (71 underwent surgery) with childhood-onset intractable epilepsy; their mean age at follow-up was 19.9 (standard deviation 4.3) years. The parent-rated Child or Adult Behavior Checklist (CBCL/ABCL) was used to document behavior prior to surgery and again 4–11 years later, and at comparable time points in the nonsurgical group. We focus primarily on externalizing and related symptomology in evaluating the CBCL/ABCL Externalizing Behavior summary scale and the Somatic Complaints, Thought Problems, Attention Problems, Aggressive Behavior, Intrusive, and Rule-breaking Behavior syndrome scales. Both groups improved in the Externalizing Behavior summary scale and in domains reflecting Somatic Complaints, Thought Problems, and Attention Problems from baseline to follow-up. Surgical and nonsurgical patients did not differ on any domain, whereas seizure-free patients had fewer symptoms in almost all behavioral domains, compared to patients with seizures. Regression analyses revealed that the most consistent predictor of improved behavior was greater behavior problems at baseline. Younger age at baseline was associated with improvements in Externalizing Behavior. The described long-term outcomes of behavior problems among patients with childhood-onset intractable epilepsy are encouraging, in that modest improvements were noted among all patient groups. Furthermore, seizure freedom, whether achieved through surgery or medication management, was associated with fewer behavioral problems in most domains.
KeywordsBehavior checklist Pediatrics Children Attention Externalizing Intractable epilepsy
We are grateful to all the participants and their parents for taking part in our study. We thank Tamara Tavares and Monique Tremblay for their assistance in data collection. This research was conducted with the support of EpLink—The Epilepsy Research Program of the Ontario Brain Institute (OBI). The OBI is an independent non-profit corporation, funded partially by the Ontario government. The opinions, results and conclusions are those of the authors and no endorsement by the OBI is intended or should be inferred.
Compliance with ethical standards
Conflicts of interest
Neither of the authors has any conflicts of interest to disclose.
The study was approved by the Research Ethics Board of the Hospital for Sick Children, and performed in accordance with ethical standards.
Informed consent/assent was obtained from patients and/or their parents prior to study participation.
- 5.Titus JB, Lee A, Kasasbeh A, Thio LL, Stephenson J, Steger-May K, Limbrick DD Jr, Smyth MD (2013) Health-related quality of life before and after pediatric epilepsy surgery: the influence of seizure outcome on changes in physical functioning and social functioning. Epilepsy Behav 27:477–483. doi: 10.1016/j.yebeh.2013.03.003 CrossRefPubMedGoogle Scholar
- 6.Andresen EN, Ramirez MJ, Kim KH, Dorfman AB, Haut JS, Klaas PA, Jehi LE, Shea K, Bingaman WE, Busch RM (2014) Effects of surgical side and site on mood and behavior outcome in children with pharmacoresistant epilepsy. Front Neurol 5:18. doi: 10.3389/fneur.2014.00018 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Hannan S, Cross JH, Scott RC, Harkness W, Heyman I (2009) The effects of epilepsy surgery on emotions, behavior, and psychosocial impairment in children and adolescents with drug-resistant epilepsy: a prospective study. Epilepsy Behav 15:318–324. doi: 10.1016/j.yebeh.2009.04.007 CrossRefPubMedGoogle Scholar
- 11.McLellan A (2015) Long-term psychiatric and behavior outcomes in children following epilepsy surgery. In: Malmgren K, Baxendale S, Cross JH (eds) Long-Term Outcomes of Epilepsy Surgery in Adults and Children. Springer International Publishing. doi: 10.1007/978-3-319-17783-0_8
- 13.Achenbach TM, Rescorla LA (2001) Manual for the ASEBA School-Age Forms and Profiles. University of Vermont, Research Center for Children, Youth & Families, Burlington, VTGoogle Scholar
- 14.Achenbach TM, Rescorla LA (2003) Manual for the ASEBA Adult Forms and Profiles. University of Vermont, Research Center for Children, Youth & Families, Burlington, VTGoogle Scholar
- 18.Puka K, Smith ML (2016) Where are they now? Psychosocial, educational and vocational outcomes after epilepsy surgery in childhood. Epilepsia. doi: 10.1111/epi.13327
- 19.PsychologicalCorporation (1997) WAIS-III WMS-III technical manual. The Psychological Corporation, San AntonioGoogle Scholar
- 20.Wechsler D (2003) Manual for Wechsler Intelligence Scale for Children, 4th edn. The Psychological Corporation, San AntonioGoogle Scholar