Journal of Neurology

, Volume 263, Issue 5, pp 991–1000 | Cite as

Long-term outcomes of behavior problems after epilepsy surgery in childhood

  • Klajdi Puka
  • Mary Lou SmithEmail author
Original Communication


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.


Behavior 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.

Ethical standards

The study was approved by the Research Ethics Board of the Hospital for Sick Children, and performed in accordance with ethical standards.

Informed consent

Informed consent/assent was obtained from patients and/or their parents prior to study participation.


  1. 1.
    Ott D, Siddarth P, Gurbani S, Koh S, Tournay A, Shields WD, Caplan R (2003) Behavioral disorders in pediatric epilepsy: unmet psychiatric need. Epilepsia 44:591–597CrossRefPubMedGoogle Scholar
  2. 2.
    Lendt M, Helmstaedter C, Kuczaty S, Schramm J, Elger CE (2000) Behavioural disorders in children with epilepsy: early improvement after surgery. J Neurol Neurosurg Psychiatry 69:739–744CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Smith ML, Elliott IM, Lach L (2004) Cognitive, psychosocial, and family function one year after pediatric epilepsy surgery. Epilepsia 45:650–660. doi: 10.1111/j.0013-9580.2004.21903.x CrossRefPubMedGoogle Scholar
  4. 4.
    McLellan A, Davies S, Heyman I, Harding B, Harkness W, Taylor D, Neville BG, Cross JH (2005) Psychopathology in children with epilepsy before and after temporal lobe resection. Dev Med Child Neurol 47:666–672. doi: 10.1017/s0012162205001362 CrossRefPubMedGoogle Scholar
  5. 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. 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
  7. 7.
    Williams J, Griebel ML, Sharp GB, Boop FA (1998) Cognition and behavior after temporal lobectomy in pediatric patients with intractable epilepsy. Pediatr Neurol 19:189–194CrossRefPubMedGoogle Scholar
  8. 8.
    Law N, Kerr EN, Smith ML (2015) Evaluation of behavioural outcomes in children 1 year after epilepsy surgery. Epilepsia. doi: 10.1111/epi.13126 PubMedGoogle Scholar
  9. 9.
    Elliott IM, Lach L, Kadis DS, Smith ML (2008) Psychosocial outcomes in children 2 years after epilepsy surgery: has anything changed? Epilepsia 49:634–641. doi: 10.1111/j.1528-1167.2007.01498.x CrossRefPubMedGoogle Scholar
  10. 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. 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
  12. 12.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381CrossRefPubMedPubMedCentralGoogle Scholar
  13. 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. 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
  15. 15.
    Tavares TP, Puka K, Smith ML (2015) Emotional functioning: long-term outcomes after pediatric epilepsy surgery. Epilepsia 56:745–753. doi: 10.111/epi.12956 CrossRefPubMedGoogle Scholar
  16. 16.
    Puka K, Tavares TP, Smith ML (2015) Development of intelligence 4 to 11 years after paediatric epilepsy surgery. J Neuropsychol. doi: 10.1111/jnp.12081 PubMedGoogle Scholar
  17. 17.
    Puka K, Smith ML (2015) Predictors of long-term quality of life after pediatric epilepsy surgery. Epilepsia 56:873–881. doi: 10.1111/epi.13004 CrossRefPubMedGoogle Scholar
  18. 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. 19.
    PsychologicalCorporation (1997) WAIS-III WMS-III technical manual. The Psychological Corporation, San AntonioGoogle Scholar
  20. 20.
    Wechsler D (2003) Manual for Wechsler Intelligence Scale for Children, 4th edn. The Psychological Corporation, San AntonioGoogle Scholar
  21. 21.
    Austin JK, Perkins SM, Johnson CS, Fastenau PS, Byars AW, deGrauw TJ, Dunn DW (2011) Behavior problems in children at time of first recognized seizure and changes over the following 3 years. Epilepsy Behav 21:373–381. doi: 10.1016/j.yebeh.2011.05.028 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Buelow JM, Austin JK, Perkins SM, Shen J, Dunn DW, Fastenau PS (2003) Behavior and mental health problems in children with epilepsy and low IQ. Dev Med Child Neurol 45:683–692CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ferro MA, Speechley KN (2009) Depressive symptoms among mothers of children with epilepsy: a review of prevalence, associated factors, and impact on children. Epilepsia 50:2344–2354. doi: 10.1111/j.1528-1167.2009.02276.x CrossRefPubMedGoogle Scholar
  24. 24.
    Lv R, Wu L, Jin L, Lu Q, Wang M, Qu Y, Liu H (2009) Depression, anxiety and quality of life in parents of children with epilepsy. Acta Neurol Scand 120:335–341. doi: 10.1111/j.1600-0404.2009.01184.x CrossRefPubMedGoogle Scholar
  25. 25.
    Karakis I, Montouris GD, Piperidou C, Luciano MS, Meador KJ, Cole AJ (2013) The effect of epilepsy surgery on caregiver quality of life. Epilepsy Res 107:181–189. doi: 10.1016/j.eplepsyres.2013.08.006 CrossRefPubMedGoogle Scholar
  26. 26.
    Smith ML, Elliott IM, Lach L (2002) Cognitive skills in children with intractable epilepsy: comparison of surgical and nonsurgical candidates. Epilepsia 43:631–637CrossRefPubMedGoogle Scholar
  27. 27.
    Edelvik A, Rydenhag B, Olsson I, Flink R, Kumlien E, Kallen K, Malmgren K (2013) Long-term outcomes of epilepsy surgery in Sweden: a national prospective and longitudinal study. Neurology 81:1244–1251. doi: 10.1212/WNL.0b013e3182a6ca7b CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Skirrow C, Cross JH, Cormack F, Harkness W, Vargha-Khadem F, Baldeweg T (2011) Long-term intellectual outcome after temporal lobe surgery in childhood. Neurology 76:1330–1337. doi: 10.1212/WNL.0b013e31821527f0 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of PsychologyThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Department of PsychologyUniversity of Toronto MississaugaMississaugaCanada
  3. 3.Neurosciences and Mental Health ProgramThe Hospital for Sick ChildrenTorontoCanada

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