Longitudinal changes in emotional functioning following pediatric resective epilepsy surgery: 2-Year follow-up

Natalie L Phillips; Elysa Widjaja; Kathy Speechley; Mark Ferro; Mary Connolly; Philippe Major; Anne Gallagher; Rajesh Ramachandrannair; Salah Almubarak; Simona Hasal; Andrea Andrade; Qi Xu; Edward Leung; O Carter Snead 3rd; Mary Lou Smith

doi:10.1016/j.yebeh.2020.107585

Longitudinal changes in emotional functioning following pediatric resective epilepsy surgery: 2-Year follow-up

Epilepsy Behav. 2021 Jan;114(Pt A):107585. doi: 10.1016/j.yebeh.2020.107585. Epub 2020 Dec 1.

Authors

Affiliations

¹ Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.
² Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
³ Departments of Paediatrics and Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁴ School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
⁵ Division of Neurology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada.
⁶ Division of Neurology, Department of Pediatrics, Ste. Justine Hospital, Montreal, QC, Canada.
⁷ Centre de Recherche, Ste. Justine Hospital, Montreal, QC, Canada.
⁸ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
⁹ Department of Pediatrics, Neurology Division, Royal University Hospital, Royal University Hospital, Saskatoon, SK, Canada; Department of Pediatrics, Neurology Division, Qatif Central Hospital, Qatif, Saudi Arabia.
¹⁰ Department of Pediatrics, London Health Sciences Center, University of Western Ontario, London, ON, Canada.
¹¹ Department of Pediatrics, Health Sciences Centre, Winnipeg, MB, Canada.
¹² Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.
¹³ Neurosciences and Mental Health Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada. Electronic address: [email protected].

PMID: 33272893
DOI: 10.1016/j.yebeh.2020.107585

Abstract

Objective: To examine longitudinal changes and predictors of depression and anxiety 2 years following resective epilepsy surgery, compared to no surgery, in children with drug-resistant epilepsy (DRE).

Method: This multicenter cohort study involved 128 children and adolescents with DRE (48 surgical, 80 nonsurgical; 8-18 years) who completed self-report measures of depression and anxiety at baseline and follow-up (6-month, 1-year, 2-year). Child demographic (age, sex, IQ) and seizure (age at onset, duration, frequency, site and side) variables were collected.

Results: Linear mixed-effects models controlling for age at enrolment found a time by treatment by seizure outcome interaction for depression. A negative linear trend across time (reduction in symptoms) was found for surgical patients, irrespective of seizure outcome. In contrast, the linear trend differed depending on seizure outcome in nonsurgical patients; a negative trend was found for those with continued seizures, whereas a positive trend (increase in symptoms) was found for those who achieved seizure freedom. Only a main effect of time was found for anxiety indicating a reduction in symptoms across patient groups. Multivariate regressions failed to find baseline predictors of depression or anxiety at 2-year follow-up in surgical patients. Older age, not baseline anxiety or depression, predicted greater symptoms of anxiety and depression at 2-year follow-up in nonsurgical patients.

Conclusion: Children with DRE reported improvement in anxiety and depression, irrespective of whether they achieve seizure control, across the 2 years following surgery. In contrast, children with DRE who did not undergo surgery, but achieved seizure freedom, reported worsening of depressive symptoms, which may indicate difficulty adjusting to life without seizures and highlight the potential need for ongoing medical and psychosocial follow-up and support.

Keywords: Anxiety; Depression; Pediatric drug-resistant epilepsy; Resective surgery; Seizures.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Aged
Child
Cohort Studies
Depression* / etiology
Epilepsy* / surgery
Follow-Up Studies
Humans
Treatment Outcome

Grants and funding

MOP-133708/Canadian Institutes for Health Research