Long-term outcomes of behavior problems after epilepsy surgery in childhood

Klajdi Puka, Mary Lou Smith

Although over 50 % of youth with intractable epilepsy present with behavioral problems, the long-term prognosis after resective epilepsy surgery in childhood is unclear. This study evaluated such outcomes in a cohort of surgical and nonsurgical patients. Participants were 108 patients (71 underwent surgery) with childhood-onset intractable epilepsy; their mean age at follow-up was 19.9 (standard deviation 4.3) years. The parent-rated Child or Adult Behavior Checklist (CBCL/ABCL) was used to document behavior prior to surgery and again 4-11 years later, and at comparable time points in the nonsurgical group. We focus primarily on externalizing and related symptomology in evaluating the CBCL/ABCL Externalizing Behavior summary scale and the Somatic Complaints, Thought Problems, Attention Problems, Aggressive Behavior, Intrusive, and Rule-breaking Behavior syndrome scales. Both groups improved in the Externalizing Behavior summary scale and in domains reflecting Somatic Complaints, Thought Problems, and Attention Problems from baseline to follow-up. Surgical and nonsurgical patients did not differ on any domain, whereas seizure-free patients had fewer symptoms in almost all behavioral domains, compared to patients with seizures. Regression analyses revealed that the most consistent predictor of improved behavior was greater behavior problems at baseline. Younger age at baseline was associated with improvements in Externalizing Behavior. The described long-term outcomes of behavior problems among patients with childhood-onset intractable epilepsy are encouraging, in that modest improvements were noted among all patient groups. Furthermore, seizure freedom, whether achieved through surgery or medication management, was associated with fewer behavioral problems in most domains.