Abstracts

Rationale: Hemispheric surgery effectively reduces seizures from pediatric drug-resistant epilepsy, but less is known about non-seizure outcomes. Prior work shows variable prevalence of different postoperative psychological diagnoses. There is a need for more complete profiling of specific behaviors and mental health symptoms that impact postoperative daily functioning and assessment of whether such outcomes correlate with age at seizure onset/surgery, resection side, or disease etiology.


Methods: We surveyed guardians of hemispheric surgery patients (66 with left-sided surgery, 76 right-sided; median/median absolute deviation of seizure onset age≅.21/.31 years; surgery age≅3.3/3.6 yr; current age≅9.5/6.6 yr). Frequencies of postoperative behaviors (including those adopted from the Patient-Reported Outcomes Measurement Information System), reported on a Likert scale, were binarized. We fit logistic regression models to predict effects (with the Wald test) of each seizure onset age, surgery age, side resected, and disease etiology on each outcome (and corrected p-values separately per outcome).


Results: Most patients need supervision for safety (81%), repeat words/actions (74%), take information literally (65%), exhibit impulsivity (64%), and interrupt conversations (61%). Most do not feel accepted (81%) and are not spoken to (80%), not helped/do not receive help from (76%), not approached by (75%), and not friended (73%) by peers. Most have attention difficulties/make errors (68%), need to read items several times to understand (68%), have difficulty making (68%) or are unable to rely on friends (65%), have difficulty paying attention for more than five to ten minutes (61%), feel upset (55%), have difficulty remembering tasks (55%), and have difficulty focusing if interrupted (55%). Patients with earlier seizure onset and surgery are more likely to be unaware of danger (χ²=16, 8.8; p< .001, =.01), need supervision (χ²=6.0, 7.0; p=.03, .03), chew on objects (χ²=10, 17; p< .01, < .001), crave chewing (χ²=10, 19; p< .01, < .001), flap arms (χ²=7.6, 14; p=.01, < .001), and not sit still (χ²=6.7, 8.2; p=.02, .02). Patients with earlier seizure onset are more likely to have attention difficulties/make errors (χ²=8.8, p=.01), and those with earlier seizure onset and surgery are more likely to have difficulty focusing if interrupted (χ²=13, 5.2; p< .01, =.05). Neither resection side nor disease etiology is associated with any tested outcome.


Conclusions: Here we show that most pediatric hemispheric surgery patients exhibit deficits in executive and psychosocial function. Several postoperative executive functions are associated with both earlier seizure onset and earlier surgery, suggesting that early epileptogenesis may affect typical neurodevelopmental processes critical for executive function. Impact on social functioning is independent of age at disease onset/surgery yet affects most children. Our results overall demonstrate a need for early behavioral/psychological intervention for pediatric drug-resistant epilepsy patients undergoing hemispheric surgery.


Funding: NIH T32GM144300 R01EY207018 P30EY08098

NSF DGE2140739

Research to Prevent Blindness Inc

Eye & Ear Foundation Pittsburgh