Pediatric epilepsy surgery improved mood, behavior in some patients


AT AES 2013

WASHINGTON – The vast majority of 100 children who underwent surgical resection for epilepsy at a single center experienced stable or significantly improved mood and anxiety symptoms after surgery.

The findings, which demonstrated good overall outcomes but differential effects based on site and side of surgery, have important implications for counseling parents about the potential effects of surgery, Elizabeth N. Andresen, Ph.D., reported at the annual meeting of the American Epilepsy Society.

The findings are important, because children with epilepsy are at high risk for depression, anxiety, and behavior problems. For example, children with epilepsy are 4.8 times more likely than are children in the general population, and 2.5 times more likely than those with other chronic conditions to develop such disturbances.

Parents are understandably concerned about how surgery might affect their child’s mood, behavior, and personality, and the few prior studies available have provided conflicting results, Dr. Andresen said.

"Now we have some good data that show that kids tend to do well: They tend to be the same, they tend to be pretty happy afterward, they tend to get better," she said.

Presurgically, 36 children with frontal lobe epilepsy reported symptoms of withdrawal and anxiety more often than did 64 children with temporal lobe epilepsy, but these symptoms improved significantly after surgery to levels comparable to or better than those in the temporal lobe epilepsy patients.

This finding was most pronounced among those who underwent left-sided surgery, Dr. Andresen of the Cleveland Clinic said at a press briefing during the meeting.

For example, presurgical T scores for anhedonia, social anxiety, and withdrawn/depression symptoms in frontal lobe vs. temporal lobe epilepsy patients who underwent left-sided surgery were 59 vs. 50, 59 vs. 49, and 59 vs. 58, respectively; after surgery, the T scores were 50 vs. 50, 42 vs. 48, and 55 vs. 59, respectively.

Scores for patients who underwent left-sided surgery significantly improved in evaluations at about 10 months on the social anxiety subscale of the Revised Children’s Manifest Anxiety Scale (RCMAS) and the withdrawal subscale of the Achenbach Child Behavior Checklist (CBCL). Surgical site or type of epilepsy did not appear to influence general improvement on the negative mood subscale of the Children’s Depression Inventory (CDI) and the worry subscale of the RCMAS, Dr. Andresen said.

Similarly, the improvement seen over time across the groups on the withdrawal, social problems, thought problems, and attention problems subscales of the CBCL did not appear to be related to the surgical site.

At the individual level, change scores on the CDI and RCMAS demonstrated clinically significant improvement in overall depression symptoms in 21% of patients overall, including 15% of temporal lobe patients and 33% of frontal lobe epilepsy patients, and in overall anxiety symptoms in 38% of patients overall, including 27% of temporal lobe epilepsy patients and 45% of frontal lobe epilepsy patients.

Particularly pronounced effects were seen with respect to anhedonia and social anxiety in those with frontal lobe epilepsy who underwent left-sided surgery, with 63% and 100% of those patients experiencing improvement on those measures, respectively.

When children with and without depression prior to surgery were analyzed separately, Dr. Andresen found that only 6% of those without depression developed depression after surgery, while 64% of those with depression before surgery were no longer depressed after surgery. Similarly, 11% of those without anxiety before surgery developed anxiety after surgery, while 40% of those with anxiety before surgery were not anxious after surgery.

The proportion of surgery patients developing new depression and anxiety was similar to the proportion of nonsurgical control patients who developed depression or anxiety over 6 months (6% and 15%), Dr. Andresen noted.

"So it looks like surgery isn’t having a big effect on the rate of new problems," she said, noting that while it isn’t having a huge effect "on the rate of making those problems go away," the numbers are moving in the right direction.

Of 64 patients treated for temporal lobe epilepsy, 38 underwent left-sided surgery and 26 underwent right-sided surgery. The other group of 36 patients with frontal lobe epilepsy included 16 who underwent left-sided surgery and 20 who underwent right-sided surgery. Another 53 patients who did not undergo surgery served as controls. Children included in the study were aged 5-16 years (mean of 11 years) with a mean age of epilepsy onset at 5.8 years and a mean duration of 5.3 years. All were taking at least two antiepileptic drugs.

Dr. Andresen said that she had no disclosures.

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