Emotional functioning: Long‐term outcomes after pediatric epilepsy surgery

Abstract

Summary Objective Children with epilepsy are at a high risk for developing symptoms of anxiety and depression. By improving seizure control, epilepsy surgery has the potential to improve patients’ anxiety and depression symptoms. Few studies have assessed the long‐term outcomes of anxiety and depressive symptoms after pediatric epilepsy surgery while using an appropriate control group. This study examined anxiety and depressive symptoms 4–11 years after surgery in surgical patients and in a control group of nonsurgical patients with pediatric‐onset epilepsy. Methods Seventy‐three surgical patients with a mean age of 19.87 (standard deviation [SD] 4.46, range 10.08–28.50) and 40 nonsurgical controls with a mean age of 20.31 (SD 4.01, range 12.08–27.25) completed the study measures. Patients completed the Child Depression Inventory II/Beck Depression Inventory II and State Trait Anxiety Inventory for Children/State Trait Anxiety Inventory and parents completed the Child Behavior Checklist/Adult Behavior Checklist to assess the patients’ anxiety and depressive symptoms. Baseline measurements of affective symptoms (Child Behavior Checklist) were retrieved from the patients’ medical records. Results Patient‐reported affective functioning was obtained at the follow‐up visit only. Patient‐reported depressive symptoms and state and trait anxiety were similar for both groups. Based on parent reports at follow‐up, patients with seizures were found to have significantly more depressive problems and anxious/depressed symptoms, and marginally more withdrawn symptoms relative to patients without seizures. Significance Seizure status was related to the presence of affective symptoms, irrespective of whether the patient had undergone surgery. In addition, parents and not patients reported the presence of anxiety and depressive symptoms, which indicates the importance of obtaining multiple informants to assess affective symptomatology.

Seizure freedom improves health‐related quality of life after epilepsy surgery in children

“…However, there was lack of consensus with respect to changes in behavior and well-being after surgery amongst those who were seizure-free, with some reporting no change in behaviour 17,18 or well-being 18,19,21 and others reporting an improvement in behaviour 19,22 or wellbeing. 20,36,37 Potential reasons for the lack of consensus in findings could be related to small sample size, 17,23 use of variable HRQoL instruments, lack of a pharmacological comparison group, [17][18][19][20] or lack of presurgical baseline HRQoL measurements. [20][21][22][23] Figure 2: The relationship between treatment (surgery vs pharmacological management) and total Quality of Life in Childhood Epilepsy (QOLCE) score at 1-year follow-up is mediated by seizure control, adjusting for baseline total QOLCE score.…”

Development of intelligence 4 to 11 years after paediatric epilepsy surgery

“…The data were collected as part of a larger study examining multiple long‐term outcomes following epilepsy surgery in childhood, including quality of life (Puka & Smith, ) and emotional functioning (Tavares, Puka & Smith, ). The study was approved by the Research Ethics Board of the Hospital for Sick Children, and informed consent/assent was obtained from the patients and/or their parents.…”

Where are they now? Psychosocial, educational, and vocational outcomes after epilepsy surgery in childhood

“…Cutoff scores on the scales allow for scores to be classified as “normal,” “borderline,” or “clinical”; those in the borderline and clinical range score at ≥93rd percentile. Due to small sample sizes of patients in the borderline and clinical range (ranging from 0 to 20 patients), scores falling in these latter classifications were categorized together as “abnormal.” As part of the larger research project, we have previously reported on a subset of other subscales of the ABCL in this sample and on intellectual outcomes …”

“…Due to small sample sizes of patients in the borderline and clinical range (ranging from 0 to 20 patients), scores falling in these latter classifications were categorized together as "abnormal." As part of the larger research project, [13][14][15] we have previously reported on a subset of other subscales of the ABCL in this sample 15 and on intellectual outcomes. 14 Patients were asked to complete a demographic questionnaire inquiring about their current education, employment, income, and social functioning.…”