Psychosocial functioning following surgical treatment for intractable epilepsy in childhood (original) (raw)
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Social functioning of children after epilepsy surgery: A literature review
Epilepsy & Behavior
This literature review on social functioning of children after epilepsy surgery is based on 24 papers addressing two categories of social functioning: social cognition (n = 4) and general social functioning (n = 20). Overall, studies that compared with healthy peers revealed children who had undergone epilepsy surgery to have more problems in both social cognition and general social functioning. Half of the studies found some improvement in social functioning in the first year(s) after epilepsy surgery, but this pertained to general social functioning, not to social cognition. The persistence of the problems in social cognition after surgery may be related to the critical period of brain maturation, lacking improvement of impairments in related cognitive domains or to a defective underlying brain conditionrather than to the epilepsy. Problems in general social functioning may be explained by the adjustments the children and their families had to make because of the child's drug-resistant epilepsy and difficulties to adjust to the new situation after surgery. The neurological and behavioral explanations are likely to be interrelated in light of the multifaceted and complex nature of social functioning. Epilepsy surgery does not appear to solve the problems in social functioning associated with having had drug-resistant epilepsy. As social functioning is an important aspect of healthy development, it should be assessed comprehensively in order to obtain a knowledge base that allows 1) proper treatment of children with epilepsy (CwE) and 2) counseling patients and families prior to and after epilepsy surgery.
Psychosocial outcomes in children two years after epilepsy surgery: Has anything changed?
Epilepsia, 2008
Purpose: 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 ≤ 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 × 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 seizurefree. 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. Discussion: 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.
Epilepsia, 2010
Purpose: The purpose of this study was to examine the social relationships and participation in educational, vocational, and community life in young adults who had undergone epilepsy surgery during childhood or adolescence. Methods: This was a retrospective, cross-sectional, casecontrolled, and multisite design study. Findings were compared between young adults who had undergone epilepsy surgery and were seizure-free in the previous 12 months (n = 38), those who had undergone epilepsy surgery and were not seizure-free (n = 33), and a group of individuals with epilepsy who had not undergone surgery (n = 31). Results: The surgical seizure-free group had significantly better general social well-being than the other two groups. Specifically, these participants were employed for more months over the past year, were less likely to report
The impact of epilepsy surgery on quality of life in children
Neurology, 2006
To determine if epilepsy surgery is effective in improving the quality of life (QOL) of children with intractable seizures using the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). Methods: The authors conducted a prospective study of the families of 35 children with intractable epilepsy who underwent epilepsy surgery. Parents completed the QOLCE preoperatively and again 6 to 18 months after surgery. At both assessment dates parents indicated the severity of their child's seizures during the past 6 months and the frequency of their child's seizures during the past 4 weeks on Likert-type scales. Children were split into two groups according to surgery outcome: seizure free vs persistent seizures. Statistical analyses were conducted to determine if children rendered seizure free showed a greater improvement in QOL compared to those with persistent seizures postoperatively. Results: Greater improvement in QOL was documented for children rendered seizure free vs children with persistent seizures. This was significant for the overall QOLCE QOL score and subscales assessing cognitive, social, emotional, behavioral, and physical domains of life. Conclusions: Epilepsy surgery improves the quality of life of children rendered seizure free. Families can be counseled preoperatively of the potential benefits of surgery beyond seizure reduction.
Do behavior and emotions improve after pediatric epilepsy surgery? A systematic review
Epilepsia, 2019
Number of figures: 1 Number of tables: 3 Number of references: 39 2 Reilly et al Short title: Behavioral outcomes after paediatric epilepsy surgery 3 Reilly et al Summary Objective: The objective was to systematically review studies which have focussed on the behavioral and emotional functioning before (baseline) and after (follow-up) paediatric epilepsy surgery. Methods: The systematic review as carried out according to PRISMA guidelines. Pubmed and Embase were searched from inception. Findings are described with respect to 1.) Changes in behavior and emotions between baseline and follow-up 2.) Factors associated with changes in behavior and emotions 3.) The impact of study quality on findings. Results: Fifteen studies met inclusion criteria. The majority of studies employed parent report screening checklists. In these studies scores were reported to have significantly improved at follow-up on at least one domain in seven studies and not changed significantly in two studies. In no studies was a deterioration in behavior noted. In studies which used DSM clinical diagnoses, no significant change was noted in the numbers of children diagnosed at baseline and at follow-up. In total 21 children lost diagnoses whilst 16 children developed new diagnoses. A better seizure outcome was associated with improvements in behavioralemotional functioning at follow-up in three of the four studies where it was considered. In terms of study quality none of the studies were rated as strong (i.e. had no weak ratings on a quality assessment tool). Significance: There is some evidence of improvement in emotional and behavioral functioning after epilepsy surgery. However, this is confined to scores on parent reported screening measures of emotional and behavioral symptoms and not clinical diagnoses. Future research should focus on including responses from multiple respondents (child, parent, teacher) when using screening instruments, but also diagnostic interviews. There is a need for long-term follow-up (beyond 2 years) with sufficiently large samples sizes including data from non-surgery controls to understand factors associated with changes in functioning post-surgery.
Epilepsy & Behavior, 2009
This study examines change in behavioral disorders and psychosocial impairment following epilepsy surgery in 13 children and adolescents with drug-resistant epilepsy. Subjects were screened for emotional and behavioral symptoms four times pre-and postoperatively using the Strengths and Difficulties Questionnaire, and were followed for up to 8.5 years after surgery. The results of this study demonstrated significantly lower scores in emotional and behavioral symptoms after surgery. A downward trend in total difficulty scores for the group was demonstrated over the three postoperative time points. The mean Impact Score showed an initial decrease at the first follow-up time point after surgery with no further improvement subsequently. Our findings suggest that emotional and behavioral symptoms in children undergoing epilepsy surgery may improve following surgery, with reduction in their functional impact, and that these improvements are maintained in the long term.
Psychosocial issues for children with epilepsy
Epilepsy & Behavior, 2011
Family problems in epilepsy Academic difficulties and epilepsy Emerging adulthood and epilepsy Epilepsy is a pervasive disorder that consists not only of seizures, but of behavioral, academic, and social difficulties. Epilepsy has an impact on the entire family and may have a significant effect on the interrelationships between child and parent. Epilepsy also has a potentially deleterious effect on academic functioning that may be the result of central nervous system dysfunction, seizures, antiepileptic drugs, or child and family response to illness. Early assessment for psychosocial problems and appropriate interventions can be beneficial for the child and family. Particular attention should be paid to periods of transition such as the move from adolescence to adulthood.
Quality of life and epilepsy surgery in childhood and adolescence
Arquivos de Neuro-Psiquiatria, 2011
Epilepsy can affect the quality of life (QOL) of patients. The temporal lobe epilepsy (TLE) is often refractory to medication, which has an adverse impact on QOL. The surgery can be a form to control the seizures and to improve the QOL of the patients. OBJECTIVE: The aim of this study was to verify the QOL of children and adolescents with TLE who underwent surgery for epilepsy, comparing QOL before and after surgery and investigating which parameters showed improvement. METHOD: We used semi-structured questionnaire in the pre-and post-surgery in 13 patients. The data were analyzed using the Wilcoxon test. RESULTS: The analysis showed that there was general improvement in the QOL postoperatively. There was improvement in general health issues, adverse effects of antiepileptic drugs and the relationship with parents. CONCLUSION: When properly indicated, epilepsy surgery improves quality of life of patients with TLE.
Epilepsy & Behavior, 2018
The objective of this study was to explore whether parents experience problems in their own psychological wellbeing and their family functioning two to four years after their child's epilepsy surgery and whether these problems are associated with epilepsy variables, demographic and cognitive variables, and parent-observed behavior problems of the child. Methods: Of the 65 approached families, parents of 31 children participated by completing the Brief Symptom Inventory (BSI), the Family Questionnaire, and the Child Behavior Checklist (CBCL). High scores indicating clinically relevant problems were reported and called 'problem scores'. Correlations between results of questionnaires and demographic and illness variables (abstracted from medical files) were computed for fathers and mothers separately. By comparing the group with at least one problem score with the group without problem scores, risk factors for parent-perceived problems in their own psychological functioning and in family functioning were explored. Results: Thirty percent of the mothers had problem scores on hostility and on communication within their family. Only a few fathers obtained problem scores, most of these pertaining to their family's organization. Not one parent had a problem score regarding their partner relationship. Many parents had problem scores on behavior problems in their child. Brain area of surgery was the only epilepsy variable related to parents' wellbeing and family functioning, with lowest problem scores for the hemispherotomy group. Scores on behavior problems in the child were also lowest for children after hemispherotomy and for those who had achieved freedom of seizures and antiepileptic drugs (AEDs). Fathers of older children experienced more problems than those of young children. Conclusions: Parent's wellbeing and family functioning cannot be understood from epilepsy or epilepsy surgery variables only but are related to the child's age and behavior. Having epilepsy is associated with emotional and behavior problems and limits children in developing age-appropriate self-dependence. These problems are not resolved after achieving seizure freedom and have great influence on the family. Professionals should set realistic expectations of epilepsy surgery and should assess, acknowledge, and follow up problems of parental psychological wellbeing and family functioning, regardless of the outcome.