Abstracts

Depression has been well documented as a common comorbid psychopathology in both adults and children diagnosed with TLE. Various studies have investigated whether or not postoperative seizure control correlates with affective disturbances post temporal lobectomy (TL) and whether there is a difference between hemispheric involvement. Results are confined to studies in adults, and findings are varied. Post-surgical depression has been less well studied in the pediatric population. The following study will explore whether a pediatric population with temporal lobe seizures demonstrates a higher incidence of affective disturbance (specifically depression/anxiety) postoperatively compared to preoperatively, and whether left versus right hemispheric involvement is associated with significant differences in affective disturbance.
We retrospectively reviewed the charts of 28 children/adolescents (14 males, 14 females; 25 right handed, 3 left handed) with left and right TLE (18 left TLE, 10 right TLE) who had undergone tailored TL for seizure remediation. Average age of seizure onset was 5.88 years (sd=5.08). Average age at surgery was 10.96 (sd=4.35). Each subject underwent neuropsychological assessment pre- and postoperatively. Mean pre- and post-surgical Full Scale IQ scores were 89.8 (sd=17.13) and 87.73 (sd=17.31), respectively. The Anxious/Depressed scales from both the Achenbach Child Behavior Checklist (CBCL) and the Achenbach Youth Self-Report (YSR) were used. Using [italic]t[/italic]-tests we compared pre-surgical left vs. right TLE scores, post-surgical left vs. right TLE scores, pre- vs. post-surgical left TLE scores, and pre- vs. post-surgical right TLE scores.
Right and left TLE patients did not differ on any of the variables observed on the CBCL¹ and YSR² in comparisons of pre-surgical left versus right TLE (p = 0.7585¹, p = 0.8352²), post-surgical left versus right TLE (p = 0.8772¹, p = 0.9092²), pre- versus post-surgical left TLE (p = 0.7552¹, p = 0.1981²), or pre- versus post-surgical right TLE (p = 0.8618¹, p = 0.3396²).
This retrospective study suggests that there are no significant differences between left and right TLE patients when compared on anxiety/depression variables from the CBCL and YSR. The question is raised as to whether or not these instruments are sensitive enough to detect mood disturbances in this population. This latter point is especially relevant when viewed from the perspective of documented clinical interventions in a number of these patients. While the small sample size of the current investigation is a limitation and caution should be taken when generalizing these findings, it would appear that more sensitive measures are needed in order to help identify potentially at-risk individuals for mood disturbances, particularly depression, prior to and following surgeries for temporal lobe seizure remediation.