Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Dec;69(6):739–744. doi: 10.1136/jnnp.69.6.739

Behavioural disorders in children with epilepsy: early improvement after surgery

M Lendt 1, C Helmstaedter 1, S Kuczaty 1, J Schramm 1, C Elger 1
PMCID: PMC1737160  PMID: 11080225

Abstract

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.
METHODS—Parents 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.
RESULTS—Preoperatively 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.
CONCLUSIONS—The 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.



Full Text

The Full Text of this article is available as a PDF (144.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aman M. G., Werry J. S., Turbott S. H. Behavior of children with seizures. Comparison with norms and effect of seizure type. J Nerv Ment Dis. 1992 Feb;180(2):124–129. doi: 10.1097/00005053-199202000-00010. [DOI] [PubMed] [Google Scholar]
  2. Austin J. K., Risinger M. W., Beckett L. A. Correlates of behavior problems in children with epilepsy. Epilepsia. 1992 Nov-Dec;33(6):1115–1122. doi: 10.1111/j.1528-1157.1992.tb01768.x. [DOI] [PubMed] [Google Scholar]
  3. Bourgeois M., Sainte-Rose C., Lellouch-Tubiana A., Malucci C., Brunelle F., Maixner W., Cinalli G., Pierre-Kahn A., Renier D., Zerah M. Surgery of epilepsy associated with focal lesions in childhood. J Neurosurg. 1999 May;90(5):833–842. doi: 10.3171/jns.1999.90.5.0833. [DOI] [PubMed] [Google Scholar]
  4. Davidson S., Falconer M. A. Outcome of surgery in 40 children with temporal-lobe epilepsy. Lancet. 1975 Jun 7;1(7919):1260–1263. doi: 10.1016/s0140-6736(75)92549-0. [DOI] [PubMed] [Google Scholar]
  5. Dorenbaum D., Cappelli M., Keene D., McGrath P. J. Use of a child behavior checklist in the psychosocial assessment of children with epilepsy. Clin Pediatr (Phila) 1985 Nov;24(11):634–637. doi: 10.1177/000992288502401106. [DOI] [PubMed] [Google Scholar]
  6. Dunn D. W., Austin J. K., Huster G. A. Behaviour problems in children with new-onset epilepsy. Seizure. 1997 Aug;6(4):283–287. [PubMed] [Google Scholar]
  7. Hermann B. P., Whitman S., Hughes J. R., Melyn M. M., Dell J. Multietiological determinants of psychopathology and social competence in children with epilepsy. Epilepsy Res. 1988 Jan-Feb;2(1):51–60. doi: 10.1016/0920-1211(88)90010-1. [DOI] [PubMed] [Google Scholar]
  8. Hoare P., Kerley S. Psychosocial adjustment of children with chronic epilepsy and their families. Dev Med Child Neurol. 1991 Mar;33(3):201–215. doi: 10.1111/j.1469-8749.1991.tb05109.x. [DOI] [PubMed] [Google Scholar]
  9. Hoare P., Mann H. Self-esteem and behavioural adjustment in children with epilepsy and children with diabetes. J Psychosom Res. 1994 Nov;38(8):859–869. doi: 10.1016/0022-3999(94)90073-6. [DOI] [PubMed] [Google Scholar]
  10. Lassonde M., Sauerwein C. Neuropsychological outcome of corpus callosotomy in children and adolescents. J Neurosurg Sci. 1997 Mar;41(1):67–73. [PubMed] [Google Scholar]
  11. Lindsay J., Glaser G., Richards P., Ounsted C. Developmental aspects of focal epilepsies of childhood treated by neurosurgery. Dev Med Child Neurol. 1984 Oct;26(5):574–587. doi: 10.1111/j.1469-8749.1984.tb04495.x. [DOI] [PubMed] [Google Scholar]
  12. OUNSTED C. The hyperkinetic syndrome in epileptic children. Lancet. 1955 Aug 13;269(6885):303–311. doi: 10.1016/s0140-6736(55)92304-7. [DOI] [PubMed] [Google Scholar]
  13. Shorvon S. D., Reynolds E. H. Reduction in polypharmacy for epilepsy. Br Med J. 1979 Oct 27;2(6197):1023–1025. doi: 10.1136/bmj.2.6197.1023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Stores G. School-children with epilepsy at risk for learning and behaviour problems. Dev Med Child Neurol. 1978 Aug;20(4):502–508. doi: 10.1111/j.1469-8749.1978.tb15256.x. [DOI] [PubMed] [Google Scholar]
  15. Verity C. M., Strauss E. H., Moyes P. D., Wada J. A., Dunn H. G., Lapointe J. S. Long-term follow-up after cerebral hemispherectomy: neurophysiologic, radiologic, and psychological findings. Neurology. 1982 Jun;32(6):629–639. doi: 10.1212/wnl.32.6.629. [DOI] [PubMed] [Google Scholar]
  16. Wilson P. J. Cerebral hemispherectomy for infantile hemiplegia. A report of 50 cases. Brain. 1970;93(1):147–180. doi: 10.1093/brain/93.1.147. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES