Psychosocial outcomes in children two years after epilepsy surgery: has anything changed?
OBJECTIVE
We prospectively explored psychosocial outcomes in children (7-18 years) 2 years after epilepsy surgery. This study built on our previous one that examined these children 1 year after surgery.


METHODS
Twenty children were studied using the Child Behavior Checklist (CBCL; a parent report instrument of potential behavioral and social problems) preoperatively, 1 year and 2 years after surgery. A comparison group of 12 children with medically refractory seizures was examined at comparable times. We conducted mixed factorial ANOVAs to determine group, time, and interaction effects, and regression analyses to assess factors driving significant (p <or= 0.05) interactions. We also investigated the proportion of children scoring in the abnormal range over time.


RESULTS
Significant main effects of time were observed on total behavior, externalizing, aggression, and delinquent behavior scales, with both groups reporting improvement. Main effects of group were observed for withdrawn and total competence scales, with the surgical group demonstrating favorable scores. Significant group x time interactions were observed on the social and social problems subscales. On both subscales, the surgical group demonstrated improvement over time, whereas the nonsurgical group experienced decline. Fifty percent of the surgical group remained seizure-free. Seizure status and number of antiepileptic medications predicted changes in social scores. We did not observe a significant regression model for the social problems subscale.


CONCLUSIONS
These findings suggest that change in social function may take time to develop after surgery. Prospective studies designed for longer periods are required to determine if improvements in other psychosocial domains are seen over time.
Elliott
Irene M
IM
Division of Neurology, and Department of Nursing, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. irene.elliott@sickkids.ca
Lach
Lucyna
L
Kadis
Darren S
DS
Smith
Mary Lou
ML
D000223:Adaptation, Psychological; D000293:Adolescent; D017668:Age of Onset; D016009:Chi-Square Distribution; D002648:Child; D015897:Comorbidity; D018572:Disease-Free Survival; D004827:Epilepsy / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D017063:Outcome Assessment, Health Care; D011184:Postoperative Period; D011446:Prospective Studies; D012044:Regression Analysis; D012917:Social Adjustment; D016896:Treatment Outcome