Do behavior and emotions improve after pediatric epilepsy surgery? A systematic review

Abstract

Objective The objective was to systematically review studies that have focused on behavioral and emotional functioning before (baseline) and after (follow‐up) pediatric epilepsy surgery. Methods The systematic review was carried out according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) 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, and (3) 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 to have changed significantly in two studies. In no studies was a deterioration in behavior noted. In studies that used Diagnostic and Statistical Manual of Mental Disorders (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, whereas 16 children developed new diagnoses. A better seizure outcome was associated with improvements in behavioral‐emotional functioning at follow‐up in three of the four studies where it was considered. In terms of study quality, none of the studies was rated as strong (ie, 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 sample sizes including data from nonsurgery controls to understand factors associated with changes in functioning postsurgery.

Parent reported health related quality of life (HRQoL) and behaviour in young people with epilepsy before and two years after epilepsy surgery

“…The improvements in behaviour reported by parents at follow-up in the current study have also been noted in the majority of other studies [21] including the only randomized control trial of epilepsy surgery in children [30]. The positive changes in behaviour occurred across all items in the survey, highlighting that improvements were not confined to either internalizing or externalizing behaviours.…”

“…These improvements in parent reported behaviour have not been found in studies which have considered clinical diagnoses of behaviour before and after surgery [18,19,31] suggesting that improvements while noticed by parents are not significant enough to warrant a change in clinical diagnosis. The significant association between improved behaviour and seizure freedom has also been found in three of four previous studies where it has been considered [21] and also in the previous study in this group of children which focussed specifically on ADHD symptoms [22]. The significant independent association between a reduction in AEDs and improved behaviour at follow-up echoes the finding that improved IQ scores are associated with AED reduction and withdrawal after paediatric epilepsy surgery independent of other determinants of outcome [32] and the finding that early AED withdrawal after surgery does not affect seizure outcome [33].…”

“…This is one of the largest studies to date to consider both HRQoL [20] and behaviour [21] before and at follow-up after paediatric epilepsy surgery. Additionally, the study includes children across the full range of intellectual functioning and considers a wide range of possible contributory factors to changes in HRQoL and behaviour.…”

“…A systematic review and meta-analysis have shown that HRQoL after paediatric epilepsy surgery improves compared with pre-surgical functioning but also compared with controls with drug resistant epilepsy who have not undergone surgery [20]. Additionally, a systematic review of behaviour and emotions before and after paediatric epilepsy surgery as measured by parental rating scales shows that behaviour and emotions improved in the majority of studies where it was considered [21]. However, the majority of studies have had small sample sizes and the studies have focussed predominantly on seizure freedom in relation to contributors to improved HRQoL and behaviour.…”

Epilepsiechirurgie: psychiatrische ontwikkelingsproblemen bij kinderen

“…In enkele gevallen ontstaat na de operatie psychiatrische co-morbiditeit. Het is mogelijk dat de epilepsie en de anti-epileptica, deze psychiatrische co-morbiditeit eerder maskeerde, of dat met het ouder worden de psychiatrische diagnose duidelijker wordt (Reilly et al, 2019b). Duidelijke risicofactoren voor het ontwikkelen van psychiatrische co-morbiditeit zijn nu niet aan te wijzen.…”