Abstracts

Rationale: This study aimed to investigate neurocognitive function, behavior problems, and parenting stress before and short-term follow-up after epilepsy surgery in children with frontal and temporal lobe epilepsy.Methods: Medical records of 46 patients with childhood-onset frontal and temporal lobe epilepsy who underwent frontal and temporal lobectomy were reviewed. A comprehensive neuropsychological assessment were administered including intelligence, attention, memory and executive functions before and after surgery. Children's behavior problems and parenting stress of their parent were evaluated by rating scales.Results: The results of 46 children and adolescents (22 males, 24 females) were analyzed. The mean age of onset was 4 y 5 mo (SD 3y 5mo), their mean age at time of surgery was 9y 9 mo (SD 4y 6mo), and the mean lead time to surgery was 6y 3mo (SD 4mo 6y). Prior to surgery, 64% of patients showed below borderline level in intelligence and significant inattention/impulsivity problems were demonstrated (abnormal range 64%). In terms of behavior problems, social problems (39%) and attention problems (36%) were significantly high to clinical level. Parent reported mildly depressed mood (mean 11.9±3.5) and high parenting stress in the area of acceptability (91.7±16.9) and demandingness (85.4 ±16.2) from child domain, and competency (83.8±12.6) from parent domain. At the short-term follow-up assessment after surgery, 73% of the surgically treated patients were seizure free. The FSIQ level improved in 42% of the surgical patients (39% in verbal comprehension, 62% in perceptual organization, 62% in free from distractibility, 83% in processing speed). Memory performance improved in 48% of the surgical patients. Notably, processing speed (73.8±5.0 vs. 80.0±5.2, p<.05) from intelligence, reaction time (62.4±4.1 vs. 52.0±3.2, p<.05), the variation of reaction time (79.9±6.9 vs. 55.7±5.8, p<.05) from attention, and attention problems from Child Behavior Checklist (64.8±2.2 vs. 60.0±2.2, p<.05) demonstrated significant change compared to pre-surgical evaluation. In addition, significant decrease in behavior problems were prominent in temporal lobe epilepsy group after surgery, which were followed by social problems (58.7±3.7 vs. 54.1±3.1, p<.05) and thought problems (57.1±2.5 vs. 53.0±1.6, p<.05). Total parenting stress had not decreased significantly in parents of patients, however, the scores on competency/depression from parent domain and distractibility/demandingness/mood from child domain decreased. Earlier age at surgery and shorter lead time to surgery were associated with better neurocognitive function and behavioral regulation.Conclusions: The necessity of long-term follow up in pediatric frontal and temporal lobe epilepsy was suggested, since there seemed to be still risk for remaining problems in neurocognitive function and behavior in short-term follow up evaluation. In addition, parents and children should be considered as being offered therapeutic intervention and parent education relating surgical intervention as well as after diagnosis for a comprehensive care.