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Updated: May 2, 2026
Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Effects of surgical side and site on mood and behavior outcome in children with pharmacoresistant epilepsy
Elizabeth N Andresen1, Maya J Ramirez1, Kevin H Kim2
1Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic , Cleveland, OH , USA.
Insights
Epilepsy surgery impacts children
Area of Science:
- Pediatric Neurology
- Neuropsychology
- Surgical Outcomes
Background:
- Children with epilepsy frequently experience mood and behavioral issues.
- Limited research exists on the emotional and behavioral effects of epilepsy surgery in pediatric populations.
- No prior studies have had adequate power to examine surgical effects based on both the side (left/right) and site (temporal/frontal) of resection.
Purpose of the Study:
- To investigate the differential emotional and behavioral outcomes following epilepsy surgery based on the side and site of resection in children.
- To assess changes in depression, anxiety, and behavioral function pre- and post-operatively.
- To identify if specific surgical locations (frontal vs. temporal) or sides (left vs. right) predict distinct emotional and behavioral trajectories.
Main Methods:
- A cohort of 100 children (aged 6-16) with pharmacoresistant epilepsy underwent pre- and post-operative neuropsychological evaluations.
- Standardized measures assessed depression, anxiety, and behavioral function.
- Data were analyzed to examine interactions between time (pre/post-surgery) and resection site (frontal/temporal) and side (left/right).
Main Results:
- Left-sided surgeries showed significant interactions: patients with frontal lobe epilepsy (FLE) had higher pre-surgical anhedonia and social anxiety, which normalized post-surgery, unlike temporal lobe epilepsy (TLE) patients.
- For left-sided surgeries, FLE patients demonstrated greater improvement in withdrawn/depressed symptoms post-operatively compared to TLE.
- Right-sided surgeries revealed general improvement over time, with caregivers of FLE patients reporting more behavioral symptoms than TLE patients pre-operatively.
Conclusions:
- This study is the first to show distinct effects of epilepsy surgery side and site on emotional and behavioral outcomes in children.
- Children with FLE may exhibit more pre-surgical emotional and behavioral challenges but experience significant improvement after surgery.
- Overall, epilepsy surgery generally leads to stable or improved emotional and behavioral health in most pediatric patients.
Abstract:
Children with epilepsy have a high rate of mood and behavior problems; yet few studies consider the emotional and behavioral impact of surgery. No study to date has been sufficiently powered to investigate effects of both side (left/right) and site (temporal/frontal) of surgery. One hundred patients (aged 6-16) and their families completed measures of depression, anxiety, and behavioral function as part of neuropsychological evaluations before and after surgery for pharmacoresistant epilepsy. Among children who had left-sided surgeries (frontal = 16; temporal = 38), there were significant interactions between time (pre to post-operative neuropsychological assessment) and resection site (frontal/temporal) on anhedonia, social anxiety, and withdrawn/depressed scales. Patients with frontal lobe epilepsy (FLE) endorsed greater pre-surgical anhedonia and social anxiety than patients with temporal lobe epilepsy (TLE) with scores normalizing following surgery. While scores on the withdrawn/depressed scale were similar between groups before surgery, the FLE group showed greater symptom improvement after surgery. In children who underwent right-sided surgeries (FLE = 20; TLE = 26), main effects of time (patients in both groups improved) and resection site (caregivers of FLE patients endorsed greater symptoms than those with TLE) were observed primarily on behavior scales. Individual data revealed that a greater proportion of children with left FLE demonstrated clinically significant improvements in anhedonia, social anxiety, and aggressive behavior than children with TLE. This is the first study to demonstrate differential effects of both side and site of surgery in children with epilepsy at group and individual levels. Results suggest that children with FLE have greater emotional and behavioral dysfunction before surgery, but show marked improvement after surgery. Overall, most children had good emotional and behavioral outcomes, with most scores remaining stable or improving.
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