Kids' Mood, Anxiety, Not Affected by Epilepsy Surgery

Pauline Anderson

December 17, 2013

WASHINGTON, DC — Epilepsy surgery doesn't appear to have a major effect on mood or anxiety in children, and some kids even do better, a new study has found.

Parents often wonder whether their child's personality will change or if he or she will become more depressed or anxious after undergoing resection of the temporal or frontal lobe, the researchers say. Until now, doctors and other experts had little psychosocial information to guide them in making a recommendation for surgery.

"But now, we have some good solid data that shows that kids tend to do well," Elizabeth Andresen, PhD, a postdoctoral fellow in neuropsychology at the Cleveland Clinic in Ohio told Medscape Medical News. "They tend to be pretty happy afterwards and they tend to get better. There's a small risk for decline and we're looking into what might be risk factors for that, but overall, kids are doing the same or even better after surgery."

Dr. Andresen presented her results here at the American Epilepsy Society (AES) 67th Annual Meeting.

Postoperative Mood

For the study, researchers used the large Cleveland Clinic database, which stores scores from neuropsychological tests completed before and 10 months after epilepsy surgery. Tests included the Children's Depression inventory, the Revised Children's Manifest Anxiety Scale, and the Achenbach Child Behavior Checklist.

The study included 153 children with epilepsy ranging in age from 5 to 16 years. Of these, 38 had left hemisphere temporal lobe epilepsy (TLE), 26 had right TLE, 17 had left frontal lobe epilepsy (FLE), and 20 had right FLE.

Before surgery, children with FLE generally had more problems with anxiety, depression, and behavior than those with TLE, but they tended to improve afterwards to levels similar to those seen with TLE, said Dr. Andresen.

These relationships were most apparent in children who underwent left-sided surgeries, she added.

The study showed clinically significant improvements in postoperative mood. For example, 21% of the sample (15% of TLE cases and 33% of FLE cases) reported improvement in overall depression symptoms after surgery.

Of kids who were depressed before surgery, about 35% still had problems with depression afterwards, but 64% were no longer depressed following their procedure.

The picture was similar for anxiety. About 38% (27% of patients with TLE and 45% of those with FLE) reported postoperative improvements in overall anxiety symptoms.

"Again, there were very low rates of new problems after surgery and pretty high rates — almost two thirds — of kids no longer having problems with anxiety after surgery," said Dr. Andresen.

She noted that kids with frontal lobe epilepsy who had surgery on the left side got better at "extremely high" rates. "In fact, on the social anxiety scale, every single kid reported what we consider clinically meaningful change."

Some children did do worse. About 6% had new problems with depression, and 11% with anxiety, after surgery.

However, Dr. Andresen pointed out that a control sample of kids with epilepsy who did not undergo surgery also developed problems — 6% developed depression and 15% anxiety.

"So having surgery doesn't increase your risk for declining in mood or anxiety after a given amount of time," said Dr. Andresen. "We thought this was pretty good news."

Results "Reassuring"

And it's "reassuring" to clinicians and parents who must decide the best course of treatment for the child, she added. If the patient is a good candidate for surgery, "and if indicators are good on the more physical level, then now nothing is holding you back," she said.

Researchers are now looking more closely at factors that may affect mood and anxiety in kids after surgery. A preliminary look at the literature suggests that the children who struggle the most are facing major transitions in their life — for example, entering high school from middle school, said Dr. Andresen.

This research received this year's AES Rebecca Goldberg Kaufman Award, given to the highest-ranked research of significance in the area of psychosocial aspects of epilepsy.

American Epilepsy Society (AES) 67th Annual Meeting. Platform B.06. Presented December 9, 2013.

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