Psychopathology in children before and after epilepsy surgery: a prospective controlled study.

Objective: This study was undertaken to prospectively assess the frequency and type of psychiatric disorders (PDs) in pediatric surgical candidates and evaluate the effects of epilepsy surgery on their psychopathological profile.

Methods: This is a prospective controlled study. Psychopathology was assessed using both diagnostic interviews and questionnaires completed by clinicians, parents, and whenever possible, patients, at baseline (T0) and 1 year after surgery in operated patients (T1) and 1 year after the first evaluation in a control group of nonoperated patients (T1). A "global assessment measure" was developed to integrate the results of the interviews, and the questionnaires were administered to multiple informants, at both T0 and T1. Descriptive statistics and multivariable analyses were performed for all outcomes. An ordinal logistic regression model was estimated to analyze the correlation between surgical treatment and possible changes in psychopathology at T1.

Results: At T0, 103 children (42 females, mean age at first evaluation = 9.5 ± 3.92 years) with lesional epilepsy were included in the study. Thirty-two patients (31.07%) had at least one PD, and 17 (16.5%) had more than one PD of any type. Sixty-two (60.2%) of 103 patients were enrolled for the T1 phase of the study, of whom 39 underwent epilepsy surgery. The ordinal logistic model revealed that patients who underwent surgery and achieved Engel class I outcome were 17.57 times (p = .047) more likely to experience improvement in their psychopathological profile than those who were not operated on and continued to experience seizures.

Significance: This prospective controlled study demonstrates a high prevalence of PD in pediatric surgical candidates and a correlation between successful surgery and reduced PD burden. An integrated approach encompassing diagnostic interviews and questionnaires, and accounting for potential disagreement between multiple informants, is essential for carefully assessing psychiatric comorbidities in children with drug-resistant seizures.