Effects of Epilepsy Surgery on Psychiatric and Behavioral Comorbidities in Children and Adolescents

W. Donald Shields, MD
David Geffen School of Medicine
University of California, Los Angeles

Abstract:

Children with epilepsy-associated psychiatric and behavioral comorbidities can be divided into two groups: (1) children with very early onset (< 5 years of age) catastrophic childhood epilepsy and (2) children or adolescents with less severe epilepsy, typically complex partial epilepsy.

Young children with catastrophic childhood epilepsy often have severe behavioral disturbances, such as hyperactivity, conduct disorders, aggression, and autism. These behavioral disorders are inextricably intertwined with epilepsy, occurring in up to 50% of such children. Furthermore, in very young children with the catastrophic childhood epilepsies, behavioral and developmental outcomes are clearly related. Early onset intractable epilepsy is often associated with mental retardation and autism. Interestingly, if mental retardation is prevented by surgical intervention, the associated autism and aggression may be prevented.

Older children who come to epilepsy surgery are most likely to have intractable complex partial epilepsy requiring temporal lobe resection. Psychiatric or behavioral disturbances are less common here than in younger children, occurring in approximately one third of patients, and approximately one third of those will have a significant improvement after surgery. However, in contrast to younger children in whom behavior almost always improves, a few older children will develop psychiatric symptoms only after surgery.