Behavioural disorders in children with epilepsy: early improvement after surgery
M Lendta, C Helmstaedtera, S Kuczatya, J Schrammb, C E Elgera
a University
Hospital of Epileptology, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany, b Department of Neurosurgery
Correspondence to: Dr M Lendt psych{at}mailer.meb.uni-bonn.de
Received 19 April 2000 and in revised form 17 July 2000;
Accepted 7 August 2000
OBJECTIVES
Epilepsy
surgery has proved to be a successful intervention method to achieve
freedom from seizures or seizure relief in children with
pharmacoresistant epilepsy. Long term studies on operated children
suggest that behavioural disorders, which are often seen before
surgery, improve after surgery. However, the early postoperative development of behavioural problems has not been systematically evaluated.
METHODSParents of 28 children with pharmacoresistant focal epilepsies completed the child
behaviour checklist (CBCL) preoperatively and 3 months after surgery.
Surgeries comprised 24 focal resections (13 temporal, 11 extratemporal), two hemispherectomies, and two callosotomies. Twenty
eight conservatively treated children with comparable CBCL scores
served as a control group. A repeated measurement multivariate analysis
of variance (MANOVA) and a regression analysis were computed to compare
the development of behaviour between both groups and to identify
predictors of postoperative changes in behaviour.
RESULTSPreoperatively
39% of the children exhibited significant behavioural problems, a
further 11% were within the borderline range. The MANOVA disclosed a
significant interaction between time of examination and group
(F=2.23, p<0.05). The surgery group showed significant improvements on the scales "internalising problems", "externalising problems", "attention problems", and "thought
problems". Behavioural problems in the control group, however,
remained unchanged. No changes were seen in social problems in both
groups. The significant predictor of total behavioural improvement was
a good seizure outcome (R2=0.11,
p<0.05). Age, sex, onset, and duration of epilepsy, the site of the
focus, and changes in antiepileptic drug regimen did not influence
changes in behaviour.
CONCLUSIONSThe data
demonstrate an early improvement of behavioural problems after epilepsy
surgery in children. The behavioural improvements can be assumed to
result directly from the removal of the epileptic focus. They are not
predictable on the basis of information available preoperatively, but
depend on the seizure outcome.
Keywords: behaviour; epilepsy; surgery; children
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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