Abstracts

Rationale: Psychiatric symptoms have been found in over 50% of children with epilepsy aged 5-16 years. It has been postulated that for those children who are candidates, epilepsy surgery will improve not only seizure control but also emotional, behavioral and social functioning. This prospective study sought to examine psychiatric functioning prior to epilepsy surgery and post surgery in pediatric patients. Psychiatric diagnoses and severity of symptoms were evaluated through psychological evaluation, standardized behavioral measures and parent report.Methods: Participants, 7 female and 10 male, had epilepsy surgery between 2005-2011. The mean age at time of surgery was 10.8 (age range from 4-17), and duration of epilepsy was 1-17 years at time of surgery. Post-surgery seizure control was 1 (11) or 2 (4) for the majority of participants as measured by Engel Class Scale. Psychiatric interviews were completed with the child and their parents and standardized behavioral self-report measures were completed as part of the their pre and post-surgical evaluations. Psychiatric diagnoses, severity of psychiatric symptoms and type of psychiatric symptoms (mood or behavioral) were obtained. Chi-square analyses were utilized to assess association between pre and post surgery psychiatric diagnoses and severity of symptoms. Results: Psychiatric diagnoses were arrived at by psychological interview, standardized self-report questionnaires and parental report of psychiatric functioning pre and post-epilepsy surgery. Subjective report by parent or child of psychological symptoms post surgery, as compared to pre-surgery functioning, was either the same or worse in 13 of the 17 (76%) participants. Psychiatric diagnoses involving mood or anxiety disorders were found in 7 (41%) participants, 4 (23%) had behavior disorders only (ADHD, Disruptive Behavior Disorder), and 4 (23%) had both mood and behavior disorders. The psychiatric symptoms present prior to surgery were associated with the type of psychiatric symptoms post surgery (p=.01). Age at time of surgery, side of surgery, type of surgery and frequency of seizures post-surgery were not associated with post-surgery psychiatric functioning or reports of emotional or behavioral functioning.Conclusions: These important findings demonstrate that children with pre-surgery psychiatric diagnoses may not improve psychiatrically following surgery even with good post-operative seizure control, and unfortunately the majority of the children may experience the same or worsening severity of psychiatric symptoms. Within this sample of patients, age, side of surgery, type of surgery and frequency of seizures post-surgery, were not associated with psychiatric diagnoses or severity of reported emotional and behavioral symptoms post-surgery. More thorough psychiatric evaluation pre-surgery and treatment for psychiatric symptoms, and longitudinal data on psychiatric functioning post-surgery, are necessary to improve the long-term psychiatric functioning of children with epilepsy.