Abstracts

Phase one of our longitudinal study identified few psychosocial changes in children and adolescents one year after surgery when compared with a group of youth with intractable seizures. The purpose of phase two was to determine if changes in psychosocial well being occur beyond the second year after surgery.
Data were obtained from our larger, prospective study. A sub-set of youth (19 surgery; 13 non-surgery) completed the Piers-Harris (PH) and their mothers (20 surgery; 12 non-surgery) completed the Child Behavior Checklist (CBCL) at three points in time: prior to surgery or baseline (time 1), and at 1 year (time 2) and 2 - 4 years (time 3) post-surgery or a comparable follow-up time for the non-surgery group. At baseline, groups were comparable in age, age of seizure onset, number of medications, and IQ. Repeated measures analyses were used to obtain Group X Time interactions. Linear regression analyses were undertaken within the surgical group to explore the extent to which baseline scores and seizure outcome predicted change (calculated as difference between time 3 - time 1 scores).
Fifty percent of this surgery group sub-set were seizure free at time 3. On most CBCL measures, changes over time were seen to a similar degree in both the surgery and non-surgery groups. Two Group X Time interactions were observed, with the surgery group showing improvements in the CBCL social problems sub-scale (F(2, 60) = 3.56, p [lt] .035) and the CBCL social sub-scale (F(2, 58) = 4.74, p [lt] .012). No significant differences were obtained for the PH measures. Baseline (time 1) performance predicted change on most CBCL and PH scales and sub-scales. Seizure outcome (seizure free, not seizure free) predicted change toward improvement on the CBCL social sub-scale (adjusted R[sup2] = 0.335, p [lt] .008) in the seizure free group.
This study emphasizes the importance of a comparison group and longitudinal assessment to assess changes over time. Except for improvements observed on the CBCL social problems and social scales, changes found within the surgical group on other CBCL scales were seen to a similar degree in the non-surgical group. Of particular interest, youth did not report any significant changes or interactions on the PH scales. The hoped for improvements in behavior and emotional functioning anticipated by families and youth may not be realised. These findings provide direction for discussions with youth and their families regarding realistic expectations of surgery outcomes.
[Supported by: The Ontario Mental Health Foundation]