Abstracts

Rationale: Children with epilepsy often exhibit more behavioral problems than healthy children and children with other chronic illnesses. Along with the demonstrated success of epilepsy surgery in reducing seizure burden, research indicates improved behavior after surgery. It is unclear if the reported behavioral improvements can be attributed to surgery or other factors. This study examines postoperative behavioral change in children following epilepsy surgery as compared to a control group of children with epilepsy who have not had surgery. Methods: Using the Child Behavior Checklist for Ages 6-18 (CBCL), change in behavior was examined in 113 pediatric patients (mean age=10.85) after epilepsy surgery as compared to 42 nonsurgical pediatric epilepsy patients (mean age=10.21) taking AEDs for seizure control. The surgical and control groups did not differ significantly in demographic composition or seizure variables; however, the surgical group scored significantly higher on Social Problems than the nonsurgical group presurgically. Change in behavior was assessed with a series of repeated-measures ANOVAs. Then, using a 10-point standard deviation change in t-score to define meaningful change, subjects were classified as improved, declined, or unchanged. Chi-squares were used to analyze differences in behavior outcome between the surgical and nonsurgical groups. Results: There was a significant interaction between time and group on Thought Problems [F(153)=7.071, p=.009] as well as trends toward significant interactions on Social Problems [F(153)=3.479, p=.064] and Aggressive Behavior [F(153)=3.388, p=.068]. For all three scales, the control group maintained relatively stable scores over time while the surgical group showed a mean decrease in endorsed behavior problems following surgery. Significant main effects were observed on Somatic Complaints and Attention Problems, with both groups showing significant improvements over time. No significant group differences were observed on the remaining scales. Chi-square analyses revealed that a larger percentage of surgical patients showed improvements on Somatic Complaints [χ²(2)=6.057, p=.048] than nonsurgical patients. A greater percent of surgical patients also reported improvements on Thought Problems, while a greater percentage of nonsurgical patients reported declines on this scale [χ²(2)=6.159, p=.046]. The same trend was apparent on Social Problems [χ²(2)=5.408, p=.067]. Conclusions: Caregivers report fewer thought problems and social difficulties and less aggressive behavior following epilepsy surgery in children. These improvements appear to be largely attributable to surgery as caregivers of nonsurgical children do not report significant behavior changes on these scales over the same time interval. Interestingly, both surgical and control groups showed improvements on scales assessing Somatic Complaints and Attention Problems, suggesting changes in these reported symptoms over time are not specific to surgery. Further research into predictors of behavior change and examination of side and site of surgery is suggested.