Impact of resective surgery for pediatric drug-resistant epilepsy on emotional functioning.
Epilepsy Behav
; 101(Pt A): 106508, 2019 12.
Article
in En
| MEDLINE
| ID: mdl-31677581
ABSTRACT
OBJECTIVE:
The objective of the study was to evaluate emotional functioning following surgical and medical treatment in children with drug-resistant epilepsy (DRE; i.e., uncontrolled seizures despite treatment with ≥2 antiepileptic drugs [AED]).METHOD:
This prospective, longitudinal, multicenter study involved 128 children and adolescents (8-18â¯years) with DRE who were assessed for surgical candidacy; 48 went on to have surgery and 80 continued medical treatment. Participants completed child-validated self-report measures of anxiety and depression at baseline, 6, and 12â¯month follow-up. Standardized z-scores were calculated with higher scores indicative of greater symptoms.RESULTS:
At baseline, 16% and 22% of all patients reported elevated symptoms of depression and anxiety, respectively (i.e., zâ¯≥â¯1.00). Seizure freedom was higher in the surgical, compared with the medical, group at 6 (64 vs. 11%) and 12â¯month (77 vs. 24%) follow-up. Linear mixed effects models controlling for age found a main effect of time for both depression and anxiety; scores decreased over time for all patients. A main effect of seizure outcome was found for depression, but not anxiety; seizure freedom was associated with lower scores overall. There were no main effects of treatment or significant interactions. Multiple regression analyses found baseline mood predicted outcomes at 6 and 12â¯month follow-up; higher anxiety and depression scores at baseline were associated with higher scores at follow-up. Older age and greater number of AEDs at baseline was associated with higher depression scores at 12â¯month follow-up.CONCLUSION:
Overall, patients reported a reduction in anxiety and depressive symptoms over the first 12â¯months, irrespective of treatment, and baseline level of functioning was the best predictor of outcome. Despite more children achieving seizure freedom with surgery compared with medical treatment, surgery was not associated with better outcomes over time. It may be that changes in anxiety and depression require a longer time to emerge postsurgery; however, being seizure-free is associated with fewer depressive symptoms, irrespective of treatment type.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Anxiety
/
Brain
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Neurosurgical Procedures
/
Depression
/
Emotions
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Drug Resistant Epilepsy
Type of study:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adolescent
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Child
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Female
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Humans
/
Male
Language:
En
Year:
2019
Type:
Article