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Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Evaluation of behavioral outcomes in children 1 year after epilepsy surgery
Nicole Law1,2,3, Elizabeth Kerr2,4, Mary Lou Smith1,2,3
1Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
Insights
Epilepsy surgery did not significantly improve behavior in children within the first year. Underlying brain abnormalities, rather than seizure control, may influence behavior, suggesting longer-term observation is needed for potential improvements.
Area of Science:
- Pediatric Neurology
- Child Psychology
- Epileptology
Background:
- Children with epilepsy often exhibit behavioral problems.
- Previous research on epilepsy surgery's impact on behavior yields inconsistent results.
- This study investigates behavioral changes in a large cohort of children undergoing epilepsy surgery.
Purpose of the Study:
- To assess the effect of epilepsy surgery on behavioral problems in children.
- To compare behavioral changes between surgical and non-surgical groups.
- To explore the influence of epilepsy-related and cognitive factors on behavior post-surgery.
Main Methods:
- Parent-reported behavior was assessed using the Child Behavior Checklist (CBCL) in 147 surgical and 40 non-surgical children.
- Data collection occurred at baseline (pre-surgery) and approximately one year post-surgery.
- Groups were compared on demographic, epilepsy, and cognitive variables.
Main Results:
- No significant behavioral changes were observed related to surgical status or seizure outcome within one year.
- Children with temporal lobe epilepsy foci showed more externalizing behaviors.
- Frontal lobe excisions were associated with poorer attention compared to other surgical sites.
Conclusions:
- Epilepsy surgery and seizure freedom do not appear to impact behavior in the first year post-operation.
- Abnormal neural substrates, not just seizure control, may drive behavioral issues in pediatric epilepsy.
- Behavioral improvements may necessitate longer follow-up periods or some behaviors may be resistant to change.
Objective:
Children with epilepsy have elevated rates of behavior problems. Research findings on the impact of epilepsy surgery on children's behavior have been mixed, with some studies showing improvements in behavior 3 to 18 months after surgery and other studies finding no change within this time interval. We examined behavior in a large surgical sample and in a nonsurgical comparison group. We also examined for potential effects of epilepsy-related and cognitive/linguistic variables.
Methods:
Behavior was assessed by parent report in 147 children who underwent epilepsy surgery and 40 children who did not, using the Child Behavior Checklist (CBCL). For the surgical group, the CBCL was completed prior to surgery (baseline) and approximately 1 year after surgery (follow-up); ratings of the nonsurgical group were also conducted twice, at comparable intervals.
Results:
At baseline, the groups did not differ on age, sex, age at seizure onset, antiepileptic drugs (AEDs), or intelligence quotient (IQ). Baseline Social and Attention Problems were higher in the nonsurgical group. At follow-up, 65% of the surgical group and 20% of the nonsurgical group were seizure-free. Behavioral change was not related to surgical status or seizure outcome. Children with temporal lobe seizure focus had more Externalizing Behaviors compared to those with frontal or multilobar foci. Attention was poorer in children who underwent frontal lobe excisions relative to temporal or multilobar excisions. Baseline IQ did not predict behavioral change.
Significance:
Our results suggest that surgery and seizure outcome do not affect behavior in the first year following surgery; it may be the abnormal neural substrate and not seizure control that influences behavior in children with epilepsy. If changes are to occur due to seizure freedom, they may require a longer time to emerge. Some behaviors may be resistant to change in children with epilepsy or may require even longer intervals for improvement.
