Abstracts

Rationale: Children coming to temporal lobe resection for the treatment of epilepsy have a high rate of psychiatric disorder. Little is known about rates of psychiatric difficulty in similar series of children undergoing extra-temporal resection for intractable seizures. The aim of this study was to establish the rates and nature of psychiatric disorders in children before and after surgery for extratemporal epilepsy. We also sought to examine the relationships between psychiatric morbidity and preoperative variables to identify possible determinants for favourable post-operative psychiatric outcome. Methods: Retrospective case note review of children undergoing extra-temporal focal resection for drug resistant epilepsy at Great Ormond Street Hospital between 1997 and 2008. Cases who underwent multi-lobar resection or functional hemispherectomy were excluded. Preoperative variables of the children such as sex, age at seizure onset and at surgery, cognitive level, family history, underlying pathology, laterality and localisation of lesion, outcome of seizures were documented. Psychiatric diagnoses were derived from pre- and post- operative mental health assessments which included an in-depth clinical interview and completion of a questionnaire. Diagnoses were grouped into the following categories: disruptive behaviour disorder, emotional disorder, social communication disorders, other major psychiatric disorders, somatoform disorder and frontal lobe behaviour. Results: Preliminary findings on 44 of the total group of about 70 patients (50% female), with a mean age at surgery of 8.48 ±4.78 years have been identified. Demographic and medical characteristics were coded. Frontal resections were performed in 68.2%, parietal in 25% and occipital in 6.8%. Operations were performed in 52.3 % of cases on the left hemisphere. A focal cortical dysplasia was identified in 52.3% of cases. 9.1% had Tuberous Sclerosis; and 18.2% tumours. A DSM IV diagnosis of psychiatric disorder was present preoperatively in 56.8% of children and postoperatively in 59.1% of children. Preoperatively, only one psychiatric diagnosis was present in 31.8%, two diagnoses in 18.2% and more than two in 4.5% whereas postoperatively, in 27.3%, in 22.7% and in 9.1% of children respectively. 84.1% of children had some degree of learning disability preoperatively and 86.4% postoperatively. Postoperatively two patients have experienced acute psychotic-like episodes . Psychotropic medication was prescribed to six patients and a new psychological support has been indicated in four patients . Conclusions: This preliminary study has found a high level of psychiatric problems both preoperatively and postoperatively in children undergoing resective surgery for extratemporal epilepsy. Children in the same epilepsy surgery program who underwent temporal lobe resection had higher rates of psychiatric disorder (72% pre-operatively and 72% post-operatively). Inclusion of further children is underway to corroborate these findings, and establish whether preoperative variables are associated with outcome.