Psychopathological Outcome After Epilepsy Surgery in Children: A Prospective Controlled Study
Abstract number :
2.288
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2022
Submission ID :
2203911
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:22 AM
Authors :
Carmen Barba, MD, PhD – Meyer Children's Hospital; Tiziana Pisano, MD – Neuroscience – Meyer Children's Hospital; Giulia Matta, MD – Neuroscience – Meyer Children's Hospital; Laura Grisotto, PhD – Statistics – University of Florence; Claudia Accolla, Psy – Neuroscience – Meyer Children's Hospital; Tiziana Metitieri, Psy – Neuroscience – Meyer Children's Hospital; Flavio Giordano, MD – Neurosurgery – Meyer Children's Hospital; Renzo Guerrini, MD, FRCP, FAES – Neuroscience – Meyer Children's Hospital
This abstract has been invited to present during the Genetics & Behavior/Neuropsychology/Language platform session
Rationale: Drug-resistant epilepsy is associated with cognitive impairment and behavioral problems. However, the psychopathological assessment is usually limited to parent-reported screening measures of behavioral symptoms and not based on clinical diagnoses. We aimed at evaluating the effect of epilepsy surgery on emotional and behavioral problems of operated children using multiple informants and the reliable change index (RCI) to measure possible postoperative changes.
Methods: This is a prospective controlled study. Inclusion criteria were: (a) age between 2 and 17 years old; (b) drug-resistant epilepsy; and (c) presurgical work-up at Meyer Hospital, Florence, Italy. Exclusion criteria were: (a) lack of informed consent; (b) coexisting progressive metabolic or genetic disorders (excluding mTOR pathway); and (c) previous brain surgeries. We compared possible psychopathology changes in operated vs. non-operated children. All patients were evaluated at baseline (T0); subsequently, operated patients were re-assessed 1 year after surgery (T1) while non-operated patients were re-evaluated 1 year after recruitment (T1). The protocol to assess psychopathology included at both T0 and T1: Child behavior checklist to parents of all recruited children and to children aged 11 to 17 years old with IQ >70; Executive Function Preschool Version (BRIEF-P) to children aged 2 to 5 years old; Conners scales to parents of all recruited children and to children aged 11 to 17 years with IQ > 70. We measured possible psychopathological changes through the RCI, and assessed their association with several variables of interest including cognitive performances, having undergone epilepsy surgery and postoperative seizure outcome, through an ordinal logistic regression model. The study was approved by the Pediatric Ethics Committee of the Tuscany Region, Italy.
Results: The final cohort included 62 patients (mean age, 10.3 ± 3.98 years; range, 3.5-17.8 years). At T1, 76.9% of operated patients were in Engel class I vs. 13% of seizure freedom in non-operated patients. Changes in the cognitive level did not influence the psychopathological outcome. Undergoing epilepsy surgery was associated with the patients’ perception of a decrease in their emotional problems and with the parents’ perception of an improvement in their children’s externalizing problems. Operated patients with Engel I-II outcome had a 9.65 greater probability of improvement in their psychopathological issues (p = 0.008) than patients who had not undergone the operation and whose epilepsy had not improved with medical treatment only.
Conclusions: Epilepsy surgery, when associated with a favorable seizure outcome, can determine a significant improvement of emotional and behavioral problems in children.
Funding: None
Surgery