Outcome trajectories after pediatric epilepsy surgery vary by biopsychosocial phenotypes
Elysa Widjaja1, Klajdi Puka2, Mary Lou Smith3,4
1Department of Medical Imaging, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
Insights
Identifying distinct biopsychosocial phenotypes in children with drug-resistant epilepsy (DRE) is key. Children with psychosocial vulnerability showed the most improvement after epilepsy surgery, suggesting surgery can improve equitable outcomes.
Area of Science:
- Pediatric Neurology
- Epileptology
- Psychosocial Health
Background:
- Drug-resistant epilepsy (DRE) significantly impacts child, parent, and family well-being.
- Understanding distinct patient profiles is crucial for optimizing treatment outcomes.
- Epilepsy surgery is a potential intervention, but its differential impact across patient phenotypes requires investigation.
Purpose of the Study:
- To identify distinct biopsychosocial phenotypes in children with DRE.
- To determine if these phenotypes influence longitudinal outcomes after epilepsy surgery versus medical management.
- To analyze the impact of treatment on child, parent, and family functioning across phenotypes.
Main Methods:
- Prospective cohort study of 105 surgical and 197 medical patients with DRE (aged 4-18).
- Hierarchical k-means clustering used to identify phenotypes based on clinical, child, parent, and family factors.
- Linear mixed models compared 2-year trajectories of health-related quality of life (HRQOL), emotional functioning, and family factors across phenotypes and treatment groups.
Main Results:
- Three phenotypes identified: psychosocial vulnerability, well-functioning, and neurological burden.
- The psychosocial vulnerability phenotype exhibited the poorest initial functioning but showed the most significant improvements in HRQOL, parent, and family functioning post-surgery.
- Well-functioning and neurological burden phenotypes demonstrated limited changes in outcomes regardless of treatment.
Conclusions:
- Biopsychosocial phenotyping can predict child, parent, and family outcomes in DRE.
- The psychosocial vulnerability phenotype benefits most from epilepsy surgery, leading to more equitable psychosocial and HRQOL outcomes.
- Targeted interventions informed by phenotyping can enhance care for children with DRE and their families.
Objective:
The aims of this study were to examine whether there are distinct biopsychosocial phenotypes among children with drug-resistant epilepsy (DRE) and to determine whether these phenotypes are related to the longitudinal trajectories of child, parent, and family outcomes after epilepsy surgery compared to medical treatment.
Methods:
This prospective cohort study recruited children with DRE aged 4-18 years who were evaluated for epilepsy surgery and their parents. Baseline clinical variables, child characteristics, parent depressive and anxiety symptoms, and family factors (household income, family demands, family resources, and satisfaction with family relationships) were used to identify distinct phenotypes using hierarchical k-means clustering. The trajectories of child health-related quality of life (HRQOL), parent depressive and anxiety symptoms, family resources, and satisfaction with family relationships over 2 years in the surgical and medical treatment groups were compared across the phenotypes using linear mixed models.
Results:
There were 105 surgical and 197 medical patients. Three distinct biopsychosocial phenotypes were identified among children with DRE: the psychosocial vulnerability phenotype had the poorest psychological and social (family) functioning, the well functioning phenotype had substantially better clinical and psychosocial functioning, and the neurological burden phenotype demonstrated the highest seizure burden and intermediate psychosocial functioning. The most pronounced improvements in child HRQOL, parent emotional functioning, and family functioning over time were observed among those with psychosocial vulnerability, especially after epilepsy surgery. The well functioning and neurological burden phenotypes showed more limited change across most outcomes in both treatment groups.
Significance:
Identifying biopsychosocial phenotypes may enhance prediction of child, parent, and family outcomes and identify children and families who could benefit from targeted interventions. Despite experiencing more psychosocial disadvantages, the psychosocial vulnerability phenotype demonstrated the largest improvement in outcomes following surgery, suggesting that surgical treatment has the potential to promote more equitable psychosocial outcomes, alongside clinical and HRQOL outcomes.
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