MOOD AND BEHAVIOR OUTCOME FOLLOWING PEDIATRIC EPILEPSY SURGERY
Authors: E. N. Andresen, M. Ramirez, A. B. Dorfman, K. Kim, P. Klaas, J. Haut, C. Kenney, W. Bingaman, R. Busch
Children with epilepsy are at high risk for depression, anxiety, and behavior problems. Studies have demonstrated mood and behavior changes following epilepsy surgery in children; however, research has been inconsistent regarding the magnitude of these changes. The present study examined changes in mood, anxiety, and behavioral functioning in children who underwent epilepsy surgery. Effects of surgical site (frontal/temporal) and side (right/left) were examined.
One hundred fifty-three pediatric patients with epilepsy (Ages 5-16; TLE: 38 left, 26 right; FLE: 17 left, 20 right) completed the Children’s Depression Inventory (CDI) and the Revised Children’s Manifest Anxiety Scale (RCMAS) as part of comprehensive neuropsychological evaluations conducted approximately 10 months apart. Their primary caregivers completed the Achenbach Child Behavior Checklist (CBCL) at both evaluations. Repeated measures ANOVAs were performed using bootstrapping to adjust for small sample sizes and influential cases. Significance was assessed using bootstrap-adjusted p-values. One-thousand bootstrap replications were performed. The magnitude of mood and behavior change was then examined at the individual patient level.
Among children who underwent left-sided surgeries, ANOVAs revealed significant two-way interactions between time and site of surgery on the Social Anxiety subscale of the RCMAS and on the Withdrawal subscale of the CBCL. Specifically, patients with FLE (or their caregivers) endorsed more symptoms on these measures prior to surgery than the TLE group and demonstrated notable anxiety/mood improvement following surgery. Main effects of time were noted on the Negative Mood subscale of the CDI and the Worry subscale of the RCMAS, with postoperative improvements seen in both groups. Among children who underwent right-sided surgeries, no significant two-way interactions were seen. Main effects of time were observed on four CBCL subscales (Withdrawal, Social Problems, Thought Problems, and Attention Problems) as the result of postoperative symptom improvement across groups. Examination of individual change scores on the CDI and RCMAS revealed clinically significant improvements in postoperative mood and anxiety in a substantial portion of patients. For example, 21% of the sample (15% of TLE cases, 33% of FLE cases) reported improvements in overall depression symptoms after surgery, and 38% of the group (27% of TLE cases, 45% of FLE cases) reported postoperative improvements in overall anxiety symptoms.
Results suggest differential effects of surgical resection on emotional and behavioral functioning in children with epilepsy. Children with FLE reported greater symptoms of withdrawal and anxiety presurgically than children with TLE; however, symptoms of anxiety and withdrawal significantly improved following surgery to levels comparable or below the TLE group. Interestingly, these relationships were most apparent in children who underwent left-sided surgeries. Results will be discussed in the context of the existing literature.
Back to search results