Abstracts

RATIONALE: The primary goal of epilepsy surgery is complete freedom from seizures. Recent studies in adults suggest significant improvements in quality of life after surgery, but only if patients are rendered seizure free. We attempted to determine whether changes in children[ssquote]s functioning and behavior following epilepsy surgery varied according to seizure outcome.
METHODS: Retrospective review of pediatric cases (i.e., less than 18 years of age at time of surgery) identified 28 epilepsy surgery cases (mean age 11.6 years at time of surgery) that underwent a cortical resection and had psychometric testing (mean IQ 87.4) and standardized parent behavioral ratings (Child Behavior Checklist) pre- and post-surgery (mean 1.5 years post surgery). Patients were dichotomized as seizure free (n=16) or not seizure free (n=12). Maximum sensitivity was maintained by conducting individual within-subject analyses of variance on the standardized parent behavioral rating scales.
RESULTS: None of the four Competence scales changed significantly (p[gt].05) from pre- to post-surgery for either seizure outcome group. There were also no differences between patient groups on any of these measures. Ten of the eleven Problem scales also did not change significantly for either seizure group following surgery. However, there was a significant (p[lt].01) group by time interaction on the Somatic Complaints scale. Specifically, the seizure free group showed decreased somatic complaints post surgery, whereas the non-seizure free group showed increased somatic complaints post surgery. Significant between group differences were revealed on the Total, Withdrawn, Attention Problems, and Somatic Complaints scales.
CONCLUSIONS: Standardized parent ratings of behavioral functioning and problems in general did not change significantly from pre- to post-surgery regardless if outcome was seizure freedom or not. The single exception involved ratings of somatic complaints, which decreased in the seizure free group but increased in the non-seizure free group. Considering the individual items (e.g., Feels dizzy, Overtired, etc.), this scale is likely sensitive to some of the common side effects reported for antiepileptic medications. That is, not unexpectedly, the seizure free group exhibited fewer of these effects after surgery, as in many cases their medications had been reduced or discontinued, whereas the non-seizure free group[ssquote]s medications were either maintained or increased. This finding also suggests that the absence of significant findings in other domains assessed was not due merely to a lack of statistical power. These general results suggest that seizure freedom does not necessarily lead to improved behavioral functioning.