Psychopathology in children before and after surgery for extratemporal lobe epilepsy

Abstract

ADHD Attention-deficit-hyperactivity disorder ASD Autism spectrum disorder DBD(NOS) disruptive disorders not otherwise specified DSM-IV Diagnostic and Statistical Manual of Mental Disorders (4th edition) ODD ⁄ CD oppositional defiant disorder/conduct disorder AIM To establish the rates and types of psychiatric disorder in children before and after surgery for extratemporal epilepsy. Relationships between psychiatric morbidity and demographic ⁄ clinical variables were examined.METHOD A retrospective case note review of 71 children undergoing extratemporal focal resection for drug resistant epilepsy in a specialist epilepsy surgery programme between 1997 and 2008. Psychiatric diagnoses were derived from pre-and postoperative assessments according to DSM-IV criteria.RESULTS Seventy-one children (38 males, 33 females) were eligible for this study. Mean age (SD)at surgery was 9 (5) years. Frontal resections were performed in 73% of the children, parietal in 17%, and occipital in 10%. Mental health problems were present in 37 of 71 (52%) children preand ⁄ or postoperatively. A similar proportion of children had psychiatric diagnoses pre-and postoperatively: 31 of 71 (44%) and 32 of 71 (45%) respectively.INTERPRETATION Psychopathology is common in children with extratemporal epilepsy. In this sample, the impact of surgery on psychiatric symptoms was not predictable: some children were unchanged, others improved, and others acquired new psychiatric diagnoses postoperatively. Given the high rates of psychiatric disorder in this group of patients, detection and treatment of mental health needs may be important.Children with epilepsy have higher rates of psychiatric disorders than children in the general population. For example, in one epidemiological study, 29% of children with epilepsy had at least one psychiatric diagnosis, more than four times the rate in the general population. This compared with 11.6% in children with chronic physical disorders not involving the brain. 1 Psychiatric diagnoses were found in 58% of children with additional neurological problems as well as epilepsy, a finding replicated in other epidemiological samples.2 Children entering epilepsy surgery programmes are usually examples of this latter group; they almost always have a structural brain abnormality and complex epilepsy, and are, therefore, likely to have high rates of psychiatric disorder. In addition, studies of clinical samples have indicated that the psychosocial impairments in these children are significantly greater than those found in children with other chronic disorders such as diabetes or asthma 3,4 and that mental health problems contribute significantly to the overall impairment experienced by the child and family. 5The best-studied group of patients undergoing epilepsy surgery are those with temporal lobe epilepsy. In children who have undergone temporal lobe resections for epilepsy refractory to medical treatment, a previous study from our group showed that psychopathology was common and a wide range of disorders were seen, in...

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